niversity Medical Center Librarj Trent Collection OVL-Vi ■$Y)\a A* il* / ‘ / . \ / v \! ' i ; ■ ■ / i ' \ ! \ \ \ ) \ i ■ I \ V l \ / * MEDICAL SKETCHES. / • Jr r Digitized by the Internet Archive . in 2016 https://archive.org/details/medicalsketches01moor MEDICAL SKETCHES: IN TWO PARTS. By JOHN MOORE, M. D„ UT SI CiECUS ITER MONSTRARE VELITe HOR. LONDON: PRINTED FOR A. STRAHAN ; AND T. CADELL, IN TllE STRAND. MDCCLXXXVI. AAoorcs i V *" T O WILLIAM LOCK, Efq. DEAR SIR, T HE Firfb Part of this Work was begun at your feat of Nor- bury Park, where Nature and Alt are fo finely combined, and the charms of focial intercourfe and re- tirement fo happily united. It was natural therefore to think of infcrib- ing the work I was then planning, to the perfon whom fo many cir- cumftances, and all the furrounding obje&s, prefented to the mind. And, as the JubjeSis of thefe Sketches A 3 are vi DEDICATION. are highly interefting to humanity, thofe who have the happinefs of your acquaintance will readily per- ceive the propriety of addreflmg them to you. By this teftimony of my regard, however, I am confcious that I facriiice your dihike of public atten- tion to the indulgence of my own pride, in fubfcribing myfelf, with the greateft fincerity, .DEAR SIR, Your affe&ionate friend, and humble fervant, J- MOORE. PREFACE. T HESE Sketches were originally un- dertaken on the following occafion : A near relation of mine, who has the jufteft claims to my affedtion and efteem, had the health of a confiderable detachment of the foot-guards entrufted to his care at a very early period of life. They were ordered to reinforce the army at that time in Vir- ginia, under the command of Lord Corn- wallis. Anxious to perform that duty with all the efficacy in his power, he requefted me to give him in writing a few obfervations and general rules relative to the nature and treatment of the difeafes mod likely to occur during the paffage, and while the party remained feparate from the army. I accord- viii PREFACE. I accordingly drew up a hafty compen- dium or practical treatife on fundry difeafes, beginning with fevers, adding fuch direc- tions as I imagined might enable him to decide in various exigencies with greater promptitude and accuracy. Since his re- turn to England I have beftowed fome pains in improving feveral of thofe rude draughts, particularly thofe upon fevers, which from a few general ideas and detached practical hints have fwelled to the iize in which they now appear. The obfervations with which I furnifhed him on fome other difeafes are alfo con- siderably enlarged : Whether I fhall ever hazard their publication, is a point on which I am as yet undetermined. The Seven Sketches which form the Firft Part of this Work were afterwards compofed upon other occafions. They are attempts to explain in familiar language certain pro- 5 -cedes PREFACE. IX cefies continually carried on in the animal ceconomy, which are not only curious in themfelves but effential to life; and furely as interefting to mankind as any other part of natural philofophy. They may therefore be confidered as no improper in- troduction to the Practical Effays which follow ; but which, after all, I prefent to the Public with great diffidence, being confcious that dogmatic confidence in our own opinions never ftands upon more flippery ground, or is more expofed to ridicule, than when thofe opinions regard the art of medicine. \ CONTENTS. PART THE FIRST. SKETCH Pa 2 e I. On the practice of medicine 1 II. Of digeflion 66 III. 'The circulation of the blood 95 IV. Of the fecretlon or feparation of par- ticular fluids from the blood 109 V. Abforption > ■* ^54 VI. Refpiration s 79 VII. *Ihe nervous flflem 199 CONTENTS. xii PART THE SECOND. SKETCH Page I. Of fevers in general 265 II. Of inflammatory fevers 334 x III. The remittent or mixed fever 367 IV. Nervous fever « 426 M E D 1 “ MEDICAL SKETCHES. i. ON THE PRACTICE OP MEDICINE; I N the inveftigation of medical, as in that of fome other interefting fubjedts, the mind is apt to remain in a difagreeable ftate of doubt and fufpenfe, which is often augmented inftead of being removed by farther ftudy and experience. A The oppofite fyftems of medical writers, the difference in the practice, of living phyficians, and the different effects which feem to flow from the fame practice, muff B naturally 2 MEDICAL SKETCHES. naturally produce doubt in a fenfible and unprejudiced mind, and are ftrong proofs that the art of medicine itfelf is uncertain and conjectural. There are indeed phyficians who ima- gine they fully underftand the nature of every difeafe, who have high and enthufi- aftic notions of the powers of medicine, and are never diflurbed with doubts or dif- fidence of their own peculiar fagacity in the application of thofe powers. What- ever may be the opinion of the multi- tude, men of real penetration, who un- derftand character, imagine that thofe cf the above defcription are commonly found among the weak, the oftentatious and fuperficial, and feldom or never among the acute and intelligent. Great confidence in the power, and belief in the effeCt of medicine, they think, are the offspring of ignorance and credulity ; and that acute reflection and experience, while they in- ■ form MEDICAL SKETCHES. 3 form ns what art can really do in the cure of difeafes, alfo teach us what is the work of nature only j — the effed of which generally is, greatly to moderate our faith in the miraculous powers of the former* It mult be acknowledged, that few things can be more irkfome to a mind eager in the purfuit of truth, than a ftate of conftant fcepticifm. Irkfome as this ftate is, how- ever it does not lead to fuch grofs abfur- dity and fuch dangerous error, as too great confidence in our own fuperior lights, im- plicit faith in any particular fyftem, or an eager belief in fads, without repeated experience, and the moft cautious exami- nation. In tracing the annals of medicine, we find that many dodrines now exploded, and proved to be erroneous, were once fup- ported by men of the higheft medical authority. One would imagine fuch ex- B 2 amples 4 MEDICAL SKETCHES, amples would cure the moft prefumptuous of a dogmatical reliance on their own par- ticular opinions ; efpecially as their mis- takes and errors affect the lives of others. This is one benefit which the medical ftudent may derive from making himfelf acquainted with the various fyftems which have prevailed in different ages and coun- tries, although now they bear no autho- rity. To ftudy the revolutions of medicine, and know how long each opinion bore fway, by what means it was depofed, and what fucceeded and reigned in its head, is, on various accounts, expedient. However falfe ancient theories may be deemed, many of them are highly ingenious; by endea- vouring to comprehend them the mind is habituated to investigation, and Strengthen- ed by exercife ; w r e diicover what led men of great Sagacity into error ; fuch difccveries Serve as beacons to prevent us from fleering the fame courfe. — ■ — Amidft the froth of falfe MEDICAL SKETCHES. 5 falfe theory, many ufeful hints and obfer- vations may be found ; for it often happen- ed that the practice was good, even when the reafoning was founded on falfe prin- ciples. But although it is an ornamental, and in fome degree an ufeful part of knowledge, to be acquainted with the various opinions that have prevailed in the medical world, it muft be confeffed that reafonings a priori^ and fyftems founded upon them, have fel- dom led to the cure of difeafes. For that elfential part of the art of phyfic, we are indebted to the obfervations and fails re- garding the fymptoms and progrefs of difeafes, and the effeds of remedies, that have been collected in the courfe of ages by men of diligence, acutenefs, and integrity. Thofe, when feparated from that chaos of indigefted obfervations, pretended difco- yeries, and falfe fads, which are alfo on record, render the art of medicine, when B 3 pradifed 6 MEDICAL SKETCHES. praQifed by men of fenfe and integrity, a bleffing, and net a curfe, to mankind. It will be faid that the powers of thofe medicines, which are found rnoft effectual in the cure of difeafes, were not difeovered by men of uncommon fenfe and penetra- tion, but fome by mere accident, others by ignorant favages, and others we owe to the chymical enthufiafm of a credulous age, which, hot in the purfuit of the philofophers (tone, {tumbled on difeoveries in medicine and other arts, far more beneficial to man- kind than the objeft they purfued, even had they obtained it; but that few difeo- veries of this nature were made by men of fcience in confequence of itudy and re- fle&iom There is no denying this affertion, and the reafon is plain : — When the moft pro- found fagacity is exerted on fubje£ts be- yond its reach, it is on a level with the grofTeft MEDICAL SKETCHES. 7 grofTeft flupidity : A1J the fenfe and learning in the world cannot a priori find out the qualities of any fimple or mineral whatever. If the roots of rhubarb and ipecacuanha were produced to an afiembly of phyficians or chemifts, who had never feen or heard of them before, they never could, by any reafoning, examination, or procefs what- ever, difcover, that the one is poffelTed of a purgative, and the other of an emetic quality ; or if they were told that each was endowed with one of thofe qualities, all their {kill would be baffled in attempting to afcertain which was the emetic, and which the purgative. There is but one way of difcovering the qualities of thofe or any other drug, which is by trying its effedls on man or fome other animal. But although the mod ftupid of mankind has the fame power with the moft fagacious of making the experiment, the latter will, when it is B 4 made. 8 MEDICAL SKETCHES. made, turn it to more ufeful purpofes. His fuperior talents will then come into play; by reflecting on the fymptoms of difeafes, the means which nature fome- times takes to relieve or terminate them, and the analogy between one difeafe and another, he will apply the powers dif- covered in the two plants more judicioufly, and with a greater probability of fuccefa to the cure of diftempers. The earliefl: practitioners in medicine, having no recorded faCts or rules to direCt them, formed the one, and collected the other, by a diligent attention to nature. — The;; obferved aninftinCt in dogs and fome other animals, that directed them to par- ticular herbs, which feemed to relieve them in ficknefs. j Melampus, a Greek, one of the earliefl: who attempted to cure difeafes, is faid to have difcovered the cathartic quality of hellebore a MEDICAL SKETCHES. hellebore, by obferving its effects on goats. By the life of this medicine, and of cold baths, we are told he cured the daughter of Pcetus king of Argos: And afterwards he is fa'id to have cured Iphiclus, one of the heroes who attended Jafon on his argo- nautic expedition, of impotency, by giv- ing him the ruft of iron in wine. We are not particularly informed how he came to the knowledge of the cold bath, or of iron ; but we may naturally imagine, that he might difcover the ftrengthening effedl of the former, by what is produced on himfelf and others when ufed for plea- fure: the virtues of iron he muft have found out in fome fuch accidental way as he did thofe of hellebore. -A young woman, labouring under the chlorofis, or a man under a tabes of a peculiar kind, may have drank wine or fome other liquor ac- cidentally impregnated with iron, and re- ceived benefit from it ; refle&ion and reafon- ing from analogy might induce him to 8 make to MEDICAL SKETCHES. make various trials, till he applied them at laft in the fuccefsful manner above men- tioned. In certain debilitating diftempers inci- dental to both fexes, what could a modern phyfician ufe, more efficacious than fteel and the cold bath? Thus from the earlieft accounts we have of the practice of medicine, we find that experience and reafoning went hand in hand. They cannot be feparated without the moil fatal confequences ; for it is not more abfurd to imagine, that cures for difeafes are to be difcovered by dint of re- flection only, than to imagine that we can make a proper ufe of experience and obfer- vation without found reafoning. The ancients not only obferved the effeCts of that inftinCt by which brutes are directed to certain plants for relief when they I MEDICAL SKETCHES. n they are unwell, and then applied them to the complaints of men, but they alfo at- tended with diligence to the manner in which nature, when left entirely to her- felf, relieved or threw off difeafes. They perceived that certain diforders were car- ried off by fpontaneous vomitings, others by loofenels, and others by augmented perfpiration ; and having thus learned how difeafes were cured by nature, whenever her power! feemed too weak and tardy, then, and then only, they ventured to affift her by art. Here it is worthy of obfervation, that although that fenfation or inftind; by which fome animals are prompted to feledt par- ticular vegetables for the removal of difor- ders, is not given in fo ftrong or particular a degree to man ; yet nature often diredls him alfo, though in a more general way, to the bell method of relieving his complaints. In fevers, the patient generally has a de- fire 12 MEDICAL SKETCHES. fire for cooling, light, acefcent drinks, and diflikes thofe which are of a heavier and more heating nature: He covets juicy ripe fruits of various kinds, and naufeates animal food;— -a free ftream of air, and a fpacious cool bed-chamber, are equally falutary and agreeable to him; while confined air, and a fmall heated room, are pernicious and op- preffive. in thofe inftances, what the fick perfon {hews an averfion to, has a ten- dency to promote the difeafe, and what he relifhes, has an effedt in abating its violence. Other inftances of the fame kind might be enumerated ; I will confine my- felf to one, which I have frequently had occafion to obferve. Towards the end of very bad putrid fevers, when the patient, exhaufted by the violence and length of the difeafe, lay con- ftantly on his back, had continual ftartings in the tendons of the wrifts; his lips and teeth being covered with a black cruft; his tongue MEDICAL SKETCHES. *3 tongue trembling, and with difficulty held out ; the pulfe weak and quick ; in this de- plorable condition, when the patient feemed infenfible to every thing elfe, he rejected, with every mark of averfion that was in his power, medicines of every kind ; but upon his lips and tongue being moiftened with wine, he fucked it in with avidity, although he could not open his teeth fo as fully to admit a tea-fpoon. \ On perceiving this, as he would take no other cordial, nor any thing elfe, he was indulged in the wine, although the relations were often under great apprehenfions that it might have a pernicious efied, till they faw the ftrongeft evidence to the contrary. In cafes fuch as that above defcribed, I have feen wine produce effeds infinitely more beneficial than all the cordials and alexipharmics of the fhops put together.-— That / n MEDICAL SKETCHES* That quantity of wine, which in perfeff health might have occafioned intoxication, in this weakened and exhaufted condition tended only to fill and ftrengthen the pulfe, diminifh the trembling and fubfultus, diffufe a genial warmth over the {kin, and fo far from increafmg, evidently abated the ftupor and tendency to deli- rium, and faved the patient from the very jaws of death; yet the falutary effe&s of this powerful cordial in fuch cafes are 'difcovered by the defire with which na- ture infpires the patient for it in preference to every thing elfe. A return of appetite is always a favour- able fign in a fever; and it has been re- marked, that if the patient exprefles a defire for that aliment to which he fhewed a particular averfion during the former courfe of his difeafe, it is ftill more favourable ; and if he continues to beg, with perfevering cagernefs, for a little animal food, whether hlh MEDICAL SKETCHES. j$ ( fifh or flefti, he may, with caution, be indulged; for the food he fo earneftly requires, though not precifely what the phyfician would have recommended, fel- dom difagrees with him. When human reafon is clouded by dif- eafe, it appears as if nature infpired the Tick with a temporary ufe of the inftindt of other animals: and thofe phyficians feem deftitute of both reafon and inftmdt, who on every occafion . refufe to gratify them with what nature fo ftrongly indicates. While we admit that experience and obfervation are the fureft guides in the practice of medicine, it muft be granted at the fame time, that to make judicious ex- periments and accurate obfervations, to draw juft inferences from what we obferve 3 not to confound the effects of one caufe with thofe of another, and to apply our experience and obfervations to the beft 2 purpofe, *6 MEDICAL SKETCHES. purpofe, is not eafy, nor fo common a thing as is ufually believed. We hear people every day, in talking of their phyfician, ufe language of this kind — “ I own he is a very weak, filly man, but he has had a great deal of ex- perience j”— or, “ I grant you, he is an of- tentatious, parading coxcomb, — next to a fool indeed in other refpedls, but he is an excellent phyfician.” They feem to think that common fenfe diverts a man from the ftudy of his profeffion, like the French lady, who being told that her phyfician had not common fenfe, replied, “ Tant mieux, un homme qui palfe fon terns a etu- dier le fens commun, comment peut-il ap- prendre la medicine ? Monfieur l’Abbe qui parle Grec comme Homere, ne fait pas danfer.” There never was a greater abfurditv, however, than to fuppofe that a man of an MEDICAL SKETCHES. if ail uncommonly weak underftanding can be a good phyfician j he may indeed have a great deal of experience ; he may poffibly be even a man of learning, but without natural acutenefs and good fenfe there never was a good phyfician fince the world be- gan, the thing is literally impoflible. What is the bufinefs of a phyfician ?— - Why* to apply his knowledge and expe- rience to the cure of difeafes, in which he muft be directed by that degree of under- ftanding he pofTeffes; and if he is deficient in fenfe, his experience will prove a fource from which he will draw falfe inferences, and learning, if he has it, will make him more prefumptuous, and lead him farther into error. How many practitioners do we meet with, who are convinced that fevers are cured by the draughts impregnated with contrayerva root and cardiac confe&ion, C with j8 medical sketches. with which they teafe the patient every two or three hours : — And how are they con-* vinced of this ? They will anfwer, from ex- perience ; for the drugs not having actual- ly killed the patient* but only retarded his cure, he recovers at length, notwithftand- ing all the draughts he has been obliged to 1 wallow; the l'agacious dodtor imputes the cure to his own prefcriptions, and per- haps publ ithes the cafe for the benefit of pofterity. - dt r-: I . I have known a very well-meaning man miflake a prefcription of feeble efficacy for one of the mod: powerful febrifuges that even was contrived ; he had ordered it pro- bably at firft when the difeafe began to take a favourable turn, or immediately before a happy crifis took place, and imputed the whole effedt to the prefcription. He gives the fame medicine in another inllance or two, on the very day the fever commences; i 9 MEDICAL SKETCHES. commences; it is an ephemera % .and he is Confirmed in his opinion of the power of ihe medicine, he proclaims it the happieft combination that ever was invented, which by a kind of elective attraction draws the morbific matter to itfelf, and then hurries it out of the body. After a few inftances of this kind it is impoflible to open his eyes; he imputes the unfortunate termination of other cafes to fome latent caufe which op- pofed the falutary effeds of his favourite medicine. That any man, particularly a man of letters, and bred to the practice of phyfic, fhould be fo eafily deceived, could fcarcely be believed* if we did not fee fuch examples frequently, and if we did not know with what partiality mankind in ge- neral view what they confider as their own inventions, and with what complacency they embrace opinions which flatter their own judgment. * A fever that begins and ends in the compafs of one d ay. C 2 Another 20 MEDICAL SKETCHES. Another thing which prevents fome practitioners from knowing the futility of their own prefcriptions, and what nature left to herfelf can do is, that they never leave nature to herfelf. The inftant they are called, they fall to work with their draughts, juleps, and apozems, and per- fevere with unrelenting affiduity till the difeafe terminates one way or other; if the patient recovers, the medicines get the credit; if he dies, the difeafe is thought to have been incurable. The being teafed to fwallow drugs, is a fpecies of diftrefs to which the rich are more expofed than the poor, provided the latter keep out of hofpitals. Nature is al- lowed to cure as many of them as five can, and Art being little felicitous of leducing fuch patients out of her filler’s hands, they generally have real need of medicines be- fore they are preffed to take them. But a phyfician whofe pra&ice lies among the 4 higheft / MEDICAL SKETCHES. 21 higheft fpheres of life, if it amounts to three thoufand pounds yearly, is fuppofed, at a moderate computation, to receive two thou- fand five hundred of that fum for preferr- ing for imaginary complaints, or fuch as would have difappeared fully as foon had they been left to themfelves. But this ought not to be imputed as a crime to the phyfician ; if an old lady cannot dine with, comfort till he has felt her pulfe, looked at her tongue, and told her whether her chicken fhould be roafted or boiled, it is reafonable he fhould be paid for his trouble. The difference between a good phyfician. and a bad one is certainly very great ; but the difference between a good phyfician and no phyfician at all, in many cafes, is very little. If during the courfe of the common epidemic difeafes which occur in this ifland every fpring and autumn, two hundred C 3 patients 22 MEDICAL SKETCHES. patients were taken prbmifeuoiifly, and one half delivered to the care of the faculty- to be treated according to art; that is, as pri- vate patients by whom they are fee’d every time they prefcribe; and the other half de- livered to the care of nurfes, intruded to give them no phyfic whatever, but merely cooling drinks, and fuch light and fimple food as the patients appetites might lead them to with for, I am convinced the world would be a good deal furprifed at the refult of the experiment. It is aftonifhing how exceedingly apt me- dical practitioners of every denomination are to impute to drugs that falutary effeCt which proceeds from the univerfal influence of another caufe, which caufe is that in- herent bias obfervable in the animal oeco- nomy to reftore health ; for as the lur- face of a lake which clearly reflects the fky and hills and verdant fcenes around its borders, when it is dilturbed by the fall- ing of a {tone, immediately endeavours to recover 23 MEDICAL SKETCHES. recover its fcattered images, and reftore them to the fame beauteous order in which they are wont to appear; in like manner when the natural . courfe of the animal oeconomy is interrupted and dffturbed by difeafe, the powers of the conftitution are continually endeavouring to reftore its or- gans to the perfect ufe of their functions, and to recover its ufual vigour and ferenity. This vis medic atrix natures, this con- ftant tendency in nature to overcome dif- eafe and reftore health, was observed by the father of medicine ; and a fentiment to the fame purpofe is the very firft exprefied by Sydenham in his ineftimable work, and is acknowledged by all candid and difcern- ipg practitioners, to have a powerful in- fluence in the cure of difeafes, Indeed I am inclined to believe that phyficians, in proportion to their candour and difcern- ment, acknowledge and rely upon this power in nature; and in proportion to their C 4 felfifhnefs n MEDICAL SKETC HE S. felfifhnefs and weaknefs, impute every re~ eovery to their own prefcriptions. A judicious and experienced phyfician confiders himfelf merely as an affiftant to nature; when her force feems to be fuffi- cient, he leaves her to perform the cure; when fhe feems too feeble, he affifts her by every means in his power. His patients, therefore, are fure, in the firft place, of all the aid which nature can give them ; and as often as it is requifite, if art has difcover- ed or invented any thing to alleviate or remove their complaints, they are fure of that alfo. Whereas a phyfician who has an over*' weening conceit of his own powers and thofe of his art, is apt by unneceffary and officious attempts to interrupt the falutary procefs of nature, and like the inconfiderate man who would plunge his hands into the difturbed lake, in order to affift its efforts to , regain MEDICAL SKETCHES. 25 regain its loft tranquillity, he only helps to increafe the diforder and confufion he means to remedy. If well-meaning practitioners, who really wifti to do every thing in their power for the recovery of their patients, and whofe greateft errors proceed from thinking more in their power than there is, can do fo much harm j how much greater mifchief is to be dreaded from the number of cunning, unprincipled, interefted practitioners in me- dicine, who, without being deceived them- felves, impofe upon the weaknefs and cre- dulity of others. Thofe generally are men of fuperficial knowledge, of a confiderable degree of natural fhrewdnefs, and fuch a portion of impudence, as fets them above embarraflment, even when their ignorance and fraud are made manifeft. Such men ftudy the foibles of mankind, fatten on the fears and hopes and ca- prices 20 MEDICAL SKETCHES. prices of the rich valetudinarians, and Squeeze the Jail lingering fhilling out of the weakened hands of the poor. There is a kind of quackery which fome people feem to invite ; they cannot be fully convinced of their phylician’s fkill and at- tention without it. Proofs of this are tq Be met with every where : In a certain city on the continent I happened to call upon a lady, who, on account of a pain and flight fwelling in her ancle, had coni'ulted a well- known phyflcian, who, although he is ac- cufed by his brethren of much charlatanicai parade in his practice, commands the ad- t miration of his patients in a more fupreme degree than any dodtor I was ever acquaint- ed with. He had juft left her when I entered : She told me he had ordered a poultice of bread and milk to be applied to the part, and then giving her watch to her maid, fhe deiired her to take particular care that the poultice fhould be boiled exact! y four MEDICAL SKETCHES. if four minutes and a half y for fuch were the exprefs orders of Monfieur le Doefeur. On my expreffing fome furprife at the 'minute-* -nefs of thefe orders, fhe exclaimed, “ Mon Dieu, quelle precifion ! il calcule comme un i» ange 1 The fortunes that have been made, and are dill making by men of this defcription in the cities of London and Paris, and by the venders and inventors of noftrums cr fecret and infallible cures, is quite aPconifh- ing. I mention Paris and London particu- larly, becaufe though other towns are in fome degree expofed to the fame evil, yet the reputation of thofe pretended cures is always higheft where the field for impo- fition is wideft, and the chance of detection lead. This I take to be the cafe in the larged find moft populous cities, where phyficians as %% MEDICAL SKETCHES. as well as noftrums without merit have a far better chance of being efteemed, than an fmaller cities, where the real value of each mull be known to a greater propor- tion of the inhabitants. Accordingly we find that hardly any of thofe vaunted medicines •of the capitals fupport their reputation for any length of time in the provincial towns, becaufe the citizens are all in fome degree acquainted with each other, and with the circumftances of each cafe in which the medicine is ufed; its real effects therefore are more fully known. Whereas in fuch a town as London, a fair and candid invefti- gation of the merits of a noftrum is as dif- ficult as it would be fruitlefs ; for if the miftakes and forgeries brought in its fup- port fhould be detected and publifhed to- day, frefh evidence of new miracles would appear in the papers to-morrow, and the minds of the multitude -would be divided. When modefl; reafon pleads on one fide, and MEDICAL SKETCHES. 29 and aifuming ignorance on the other, we may eafily guefs which will have the ma- jority* Befides, it is to be remembered that no man has fuch an intereft in attacking, as the noftrum-monger has in defending the cha- racter of his fecret ; accordingly moft people, after they are convinced, either from their own experience or from that of others, of the futility of the medicine, give themfelves no farther trouble about it, but leave it to their neighbours to make the fame inquiry or experiment if they pleafe. This is precifely what the quack wilhes, and if numbers*/*? make the experiment, he gains his object; when his fortune is made, the reputation of his drug will give him no more concern. But in cafe by any accident its character Ihould be blafted before he has accomplilhed his object, he then metamor- phofes his infallible pills into infallible drops, gets MEDICAL SKETCHES. 3 ® gets their praifes founded, and their cures at~ tehed in the newfpapers, and very poffibly the drops will finifh what the pills began. It will be faid that the atteftations of cures are not always forgeries, for we fome- times find peoole of character allow their names to appear in fupport of the efficacy of quack medicines. To this it may be anfwered, in the firfl place, that fuch infiances are very rare, in eomparifon of the number of cbfcure and fufpicious evidences which are brought in fuch occafions ; and we muft recolledt be- fides, that a good character, though it fcreen a man from the fufpieion of being the ac- complice, yet it cannot always ' fave him from being the dupe of impofition. In difeafes which are liable to fudden tranfitions from extreme pain to perfect eafe, and where there are long intervals be- tween MEDICAL SKETCHES. tween the paroxyfms,- it is not very dif- ficult to perfuade the patient, that ho is entirely indebted to the noftrum for that abatement of his complaint which takes place at the time he ufes it : Then gratitude to a fuppofed benefactor naturally prompts him to do every thing in his power to ferve him ; and fometimes in the warmth of his zeal, efpecially when difp.uting with un- believers, he is hurried into affertions con- cerning the effects of the medicine, which in cooler moments he would not have made. The valetudinarian is often as fond of enumerating his complaints, as a foldier is of talking over his battles* And although he feldom finds a liftener, who with a greedy ear devours his difcourfe, yet like the latter he tries to create an intereh ; and to melt the heart by running through all his difajirous chances , his moving accidents and hair-breadth '/capes*. It is his hint 8 * Othello* alfo MEDICAL SKETCHES, 3 * alfo to fpeak of fome wonder-working noftrum, for it is a thoufand to one but he has fome favourite of this kind, which he ftrongly recommends, and having once re- commended, he becomes a party concerned in its caufe, he reads with pathos and energy every advertifement in its favour, he thinks his own truth and honour connected with the reputation of the medicine he praifes, and imagines he gives the ftrongeft tefti- mony of his affedtion to his friends when he teafes them to fwallow a little; it is in \ r ain they affure him they are in perfedt health, “ This drug can be taken with *■ fafety at all times; if the difeafe has ar- “ rived before it is taken, it removes it; 44 if it is only on the road, it prevents its 44 arrival.” By fuch means, many remedies which are fecrets have been brought into vogue in the courfe of our remembrance ; all of them attained a temporary reputation, which none MEDICAL SKETCHES. 32 none of them could Support for any length of time ; they were raifed to notice by the breath of impofture and the voice of ere- dulity* they funk into darknefs by the in~ trinfic tendency of their nature. One medicine muft be excepted from the negledt and contempt due to fo many others. — Dr. James’s fever powder has for a number of years enjoyed a considerable degree of reputation in this ifland, and in the colonies connected with it, although in the continent of Europe it is little ufed. In an hofpital where I had the chief care of the Tick for Several years, I took frequent occafion to compare the powers of this medicine with thofe of antimony, James’s powder being generally fuppofed to confift of a preparation of antimony and teftaceous earth, or feme other infipid powder, to dif- guife it. The antimonial with which I D brought 34 MEDICAL SKETCHES. l brought it moll frequently into comparifon, was emetic tartar, with whofe operation and cfFe&s thofe of the powder feem to have a great refemblance; whether they are ex- hibited in full dofes, fo as to excite vomit- ing and purging; or in fmaller dofes, when they produce only an increafed perfpiration, a flight degree of naufea ; and if the fmall dofes are repeated at proper intervals, fome evacuation by flool. On the firft threatening of fever, a full dofe of James’s powder operating at once as an emetic, iudorific, and cathartic, feems fometimes entirely to throw off the difeafe, and leaves the patient quite cool and free from fever; and in cafes where the fever is formed, and has continued fome time before the powder is adminiftered, it frequently diminifhes the force of the fever ; and ufed in fmall dofes as an alterative, is of fervice during the courfe of the fever. AU MEDICAL SKETCHES. 35 All thofe effeds are alfo produced by proper dofes of tartar emetic, exhibited in the fame manner. The principal dif- ference feems to confift in this, that a full dofe of tartar emetic operates, with more force and certainty, firft as an emetic, and afterwards as a purgative, than a full dofe of the powder, but, the latter with moll cer- tainty as a fudorific ; and it often appears to be as efficacious in removing or abating the feverifh fymptoms, although it operates with more mildnefs than the former. When ufed as an alterative in fmall dofes at confiderable intervals, the fourth of a common dofe of the powder is lefs apt to create a naufea, or to excite vomiting, than a Tingle grain of tartar emetic diffolved in a faline draught; in other refpeds their effeds feem fo fimilar, that in fevers where I think , antimony proper, whether at the beginning or during the progrefs, if the patient or his D 2 relations 36 MEDICAL SKETCHES. relations have a predilection for James’s powders, and feem folicitous that he fhould have it, I very cheerfully comply with their wifhes. It will be faid, that if a full dofe of James’s powder is given as above-mention- ed, at the firft threatening of a fever, al- though after its operation the patient fhould be found perfectly cool and free from fever, that is no abfolute proof that the medicine removed orprevented one, becaufe, verypof- fibly, no fever was about to form ; for there is no certain criterion by which we can diftinguifh the firft fymptoms of a fever, which will laft but one day, from thofe of one which will prove tedious and dan- gerous ; fo that James’s powder, when given at the firft attack of fuch diforders, may get the credit of curing many com- plaints, which would have gone off as foon, and more eafily, of themfelves. This MEDICAL SKETCHES. 37 This obfervation is certainly juft, but it is no jufter when ftated againft James’s pow- der, than againft antimony, or any other / medicine whatever. Some phyficians have fuch an averfion to every compofition the materials of which are kept fecret, that they will on no ac- count, and in no cafe, order them; — they imagine fuch condefcenfion beneath the dignity of the profeffion. Their diflike is, in general, well founded ; but I cannot help thinking there may be particular cafes in which there is more wifdom in the breach than the obfer vance of this general rule ; and as for the dignity of the profeffion, its chief dignity certainly confifts in curing difeafes in the fpeedieft way poffibie. In cafes where the ufual practice gene- rally fails, or in which a medicine whole compofition is kept fecret has the reputa- D 3 tion MEDICAL SKETCHES. 38 tion of acting with more efficacy than the known prefcriptions ; or even when the patient or his friends have a ftrong defire to try a particular medicine, which we know has been ufed in a thoufand inftances with fafety, in any of thofe cafes, obftinately to oppofe the trial, merely became we do not know the precife ingredients of which it is compofed, would, according to my judg- ment, be unreafonable. For let it be re- membered, that although we have not a certain knowledge of the particular ingre- dients of the medicine in queftion, yet w~e have a knowledge of its manner of operat- ing and its ufual effedfc; this is the moft material knowledge the phyfician can have. What more in reality does he know of Jefuits bark, rhubarb, or any other uncom- pounded medicine? The firft is a medicine confifting of two or three ingredients, fe- cretly mixed together by a phyfician of the name of James. The other two are medi- cines MEDICAL SKETCHES. 39 cines whofe component parts are ftill more fecretly, and in a manner lefs underftood, combined and mixed together by nature. If then he prefcribes the latter from a knowledge of their effects only, he ought not to reject: all trial of the former, merely becaufe he is unacquainted with the par- ticulars of its combination. Nobody can approve lefs than I do of the pra&ice of keeping any prefcription fe- cret, which can be of public utility ; but I cannot think that the inventors not a&ing in the molt liberal manner pcifible, is a good reafon for preventing a patient’s reap- ing the benefit of the invention. The enthufiaftic admirers of Dr. James’s powder may confider w T hat I have faid above as but cold praife: — others, whofe authority is far greater than mine, will pro- bably imagine I have gone too far, in put- ting it upon a level, in particular cafes, with D 4 any 4-0 MEDICAL SKETCHES, any preparation of one of the moft power- ful medicines in the whole materia medica. Be that as it may, what I have faid proceeds from convidtion founded on experience ; however much therefore I am perfuaded of the worthleffnefs of noftrums in general, I thought it fair to diftinguifh this from others. I know it is often faid by the advocates of other noftrums ftill in ufe, that they are condemned from interefted motives only; that phyficians, although fully fenfible of their efficacy, decry them with unceafing induftry, left coming into univerfal ufe they fhould annihilate half the difeafes of mankind, and fpoil their trade. Phyficians, no doubt, have their (hare of that ufeful jealoufy of trade which prevails in this country; yet I fhould think it rather a violent fuppofition to imagine them ca- pable MEDICAL SKETCHES. 41 pable of carrying that fpirit fo far as to allow their fellow-creatures, their relations, and friends, to perifh in torment, rather than recommend what would give them fpeedy and certain relief, merely becaufe the cure was not of their own manu- facture. 0 But I will not infill upon this argument, left I Ihould offend thofe who are of a con- trary opinion, and think a jealoufy of trade cannot be carried* too far. Let us take the fuppofition therefore for granted, and ad- mit that the whole faculty had entered into an agreement to ftifle the reputation of a difcovered cure for a difeafe for which no cure was known before,' —the gout for ex- ample. The plot would prove ineffectual: The influence of the whole faculty com- bined, and each individual adhering to the fpirit of the confederacy, could not prevent fuch a medicine from coming into univerfal life, not in this ifland only, but, in fpite of all MEDICAL SKETCHES. *2 all their jealbufy of trade, even in Holland, and all other countries*. An improvement in furgery indeed, how- ever interefting to humanity, might be kept down for a longer time, if we could fuppofe fuch an improvement would be difcouraged by the gentlemen of that profeflion; for as important operations feldom occur, and when they do, are generally performed in hofpitals, where the patient rauft fubmit in ■* all refpe&s to the fancy of the operators, fhould they y from obftinacy, pride, or any other unbecoming motive, oppofe the im- * Sir George Baker has lately, in a very curious and in- ftruflive paper, fhewed by what degrees the reputation of the Peruvian bark was ellablilhed in Europe, in fpite of all the prejudices and paffions it had to encounter, all of which it has overcome, although it was at firft introduced by the cafual experience of an uncivilized people, fup- ported by a body of men w ho are not phyficians ana never were popular, and its ufes more particularly developed by s perfon to whom the phyficians of the time gave the name of quack. — Vide Medical Tranfafiions by the College of Ply - Jiciaiu, vol. iii. provement, MEDICAL SKETCHES. 43 provement, it would of courfe be greatly- retarded in its progrefs. But a thing fo eafily tried as a medicine, and which people in pain or in danger are fo eager to make trial of, if it really pofleffed the virtues fuppofed, could not poffibly be for any confiderable time withheld from general ufe. Every day, every hour would add to its reputation; the beft attefted, fpontaneous evidence of cures would come from all quarters ; every grateful tongue would pro- claim the virtues of the medicine; thofe who talked of noftrums and quackery, would be hided into filence; and the voice of falfehood and envy would be drowned by the general fuffrage. The practice of inoculation of the fm all- pox is certainly not for the intereft of phy- fic, confidered as a trade. The prefent method was not introduced into this country by regular phyficians, who are now feldom called 44 MEDICAL SKETCHES. / called to attend patients under inoculation, and who certainly have more reafon to think this practice hurts their trade than any noftrum does; yet no fooner were its great advantages known, than it began gra- dually to be adopted, and in a very fhort time became univerfal. I do not fuppofe that the phyhcians ever oppofed it ; but if anybody choofes to aflert they did, ftill it mull be granted that their oppofition did not avail, which is all I am contending for. Nothing can be more certain therefore, than that all ufeful difcoveries whofe pre- tenhons can be brought to trial, will, in time, make their way in every nation, un- lefs indeed they are accufed of ftriking at the religion or government of the country. In England they would make their way notwithftanding, or perhaps the fooner, by their ftriking at both. It muft be acknowledged, that by the arts of fraud, irnpofture, and indefatigable puf- fing* MEDICAL SKETCHES. 45 fing, very worthlefs drugs are fometimes raifed to a reputation they do not defer ve, in Ihorter time than is required to bring an ufeful difccvery to the fame it highly merits ; •but then time is fure to fupport, confirm, and eftablifh the latter, and gradually to fhake, weaken, and at length totally to overturn the former. A ftronger proof therefore needs not be given, that the vaunted noftrums of former times were undeferving of the character they enjoy- ed, than their having gradually fallen from eminence to negledt; whereas the virtues of Jefuits bark, mercury, and other valuable medicines, have become more and more manifeft; and we fee them daily ex- tended to the relief of other complaints than thole which at firft gave them reputation. The prowefs of fuch Herculean medicines as the two juft mentioned, are ftifficient to exterminate all doubt, and eftablifh an uni- ve^fal reliance on their virtue in many I defperate 46 MEDICAL SKETCHES. defperate cafes; — but without hinting at fecret noftrums or drugs, artfully cried up for felfifh purpofes, there are medicines nniverfally known and in daily ufe, about whofe efficacy praditioners of the beft in- tentions are of very different opinions, and yet both thofe w r ho think favourably of thefe medicines, and thofe who defpife them as ufelefs, declare that they found their opinions upon experience , The explanation of this asnigma is, that the medicines in queftion, though their powers may on fome occafions be confider- able, yet on others ad very feebly, and in all cafes flowly; by which means their vir- tues appear different, and fometimes are not difeerned at all, but are entirely denied by people who have different powers of dif- cernment, and who view them in different lights* It MEDICAL SKETCHES. 47 It requires more natuial penetration and attention than many people poffefs, or are willing to beftow, to determine the genuine effedt of particular regimeis or courfes of medicine. Befides naturai acutenefs and fagacity, it requires the exact weighing of every concomitant and colliteral circum- ftance which can promote, retard, or pre- vent the effedt of the medicine at the time it is administered. It is pnper to make repeated trials, and on people of various conftitutions. It is abfolutelv requisite to have no favourite hypothefrs, to be divelied of all partiality for or prejudce againft the medicine, and in fhort to have no view but the difcovery of truth. But when fuch in- veftigations are begun by people already biaffed to one fide or the other, or when carried on carelefsly, we need not be fur- prifed to find that? the inferences are dif- ferent, though all are faid to be equally drawn from obfervation . 7 But 4 S MEDICAL SKETCHES. But as hafly and fuperficial obfervation often contributes to raife the reputation of very foolifh prefcriptions, fo it fometimes tends to injure thofe of real utility. For the fame ftrergth of underftanding which imputes faluary effedts to the former becaufe they do not always kill, will im- pute pernicious ones to the latter becaufe they do not dways cure. One declares the bark never agrees with him ; — another will fuller the moll racking pain, ratherthan fwallow any medicine, till he is allured there is no laudanum in it • — and a third vill in no cafe take mercury in any fhape oi form. All thofe people alfert, and are themfelves convinced, fiat thofe prejudices are wife conclufions, founded on the experience they have had of taeir own conftitutions ; — very polfibly thofe medicines have been given them MEDICAL SKETCHES. 49 them on feme improper occafion; or when their complaint was augmenting, and could not be hopped as foon as they expected; but nothing can be more rafh than to de- termine, becaufe a medicine does not prove immediately fuecefsful, or becaufe it has been ordered injudicioufly, that it is im- proper in every future fituation that can happen. It will be faid there ought to be great al- lowance made for the peculiarities of con- ftitutions; — that there are antipathies not founded upon reafon, but which feem in- herent in the conftitution, which, on cer- tain occafions, mull have great weight with the phyfician. Every thing of this nature ought doubt- lefs to be duly weighed ; but I am greatly miftaken if there is any human body fo framed as to render it improper in every poffible cafe to give bark, or opium, or E mercury. 50 MEDICAL SKETCHES. mercury. It frequently happens that the medicine reprobated by the prejudice of patients, is the only one which can give them effectual relief: Yielding to fuch pre- judices therefore, is a more dangerous thing than many people are aware of, and the patient ought to be reafoned out of them without lofs of time, unlefs reafon fhould unfortunately happen to be a thing which agrees with his conftitution ftill lefs than any of thofe falutary medicines to which he thews fuch an averfion. While we admit therefore, that accurate obfervations are our fureft guides, we rnuft keep in mind that carelefs and partial ones are as apt to lead to error as hypothetical reafoning itfelf. Examples are namberlefs; I will mention one where the error is as univerfal, and has continued as long as moft : I mean the notion mat the figures of animals of various kinds, MEDICAL SKETCHES. Si kinds, and other extraordinary marks, are often damped on the faces or bodies of the foetus in the womb, by the mere force of the mother’s imagination. On queftioning the people thus marked, you are generally told, “ that their mothers u while pregnant with them, were ftartled “ by the unexpected fight of a moufe, a “ rat, a fquirrel ; or that a cherry, a plum, “ a bunch of grapes, or fomething, in “ fhort, which refembles the mark, had “ been thrown at them : That this acci- “ dent had given much uneafinefs to their ^ mother; and as foon as they themfelves “ were born, the fimilitude of what had &i frightened her, whether animal, vege- il table, or whatever it had been, was found, “ as you fee, on their body,” Some years ago, I took a good deal of pains co inveftigate this matter : I converfed E 2 with 52 MEDICAL SKETCHES. with a great number of women who either had fuch marks on their bodies, or on thofe of their children. They were all in the fame dory ; the marks on their own bodies, they allured me, proceeded from fomething that had been thrown at their mothers ; thofe on their children’s bodies, from fome- thing that had been thrown at themfelves, during the courfe of their pregnancy. But on clofe inquiry, and examining the rela- tions and attendants, it appeared that the mother never had mentioned any thing of her having had a fright, or of her having an impreffion that her child would be marked, until die faw the mark ; then in- deed, and not before, {he told them of fome adventure which was the fuppofed caufe of it. This turned out to be the cafe in every indance I heard of, which could be fairly and accurately examined into. 1 When MEDICAL SKETCHES. 53 When I heard of any woman who was actually pregnant, and had met with fome accident that gave her a ftrong impreffion that the child would certainly have a pecu- liar mark, I watched the event; and the child, when born, was free from every ap- pearance of what had made fuch impreffion on the mind of the mother. In ffiort, it always happened, either that the woman faw the mark firft, and recol- lected afterwards what had occafioned it ; or if ffie really met with fome accident or fright during her pregnancy, and ventured to foretel that her child would be marked* ffie was delivered of her fears and her child together, for no mark was ever to be feen. The cafe of one lady is fo ftrongly in point, and was attended with fuch lingular circumftances, that it is worth mentioning. E 3 This 54 MEDICAL SKETCHES. This lady, who had great averfion to monldes, happened unfortunately, during the courfe of her pregnancy, to vifit in a family where one of thofe animals was the chief favourite; on being {hewed into a room, {lie feated herfelf on a chair, which hood before a table, upon which this fa- vourite was already placed he, not natu- rally of a referved difpofition, and rendered more petulant and wanton by long indul- gence, fuddenly jumped on the lady’s fhoulders: — She fcreamed, and was terri- fied, but on perceiving who had treated her with fuch indecent familiarity, {he actually fainted ; and through the remaining courfe of her pregnancy, {he had the moft painful conviction that her child would be deform- ed by fome {hocking feature, or perhaps the •whole countenance of this odious monkey. The pangs of labour did not overcome this impreflion, for in the midft of her pains MEDICAL SKETCHES. 55 pains fhe often lamented the fate of her unfortunate child, who was doomed through life to carry about a human foul in the body of an ape. When the child was born, {he called to the midwife with a lamentable voice for a fight of her unfor- tunate offspring, and was equally pleafed and furprifed when fhe received a fine boy into her arms. After having enjoyed for a few minutes all the rapture of this change to eafe and happinefs from pain and mifery, her pains returned, and the midwife inform^ ed her that there was flill another child. — Another, exclaimed fhe, then it is as I have dreaded, and this mitjl be the monkey after all. She was however once more happily undeceived; the fecond was as fine a boy as the firft : I knew them both ; — they grew to be flout comely youths, without a trace of the monkey in either their faces or difpofition. E 4 Numberlefs S 6 MEDICAL SKETCHES. Numberlefs other examples might be brought to prove the necefiity of examin- ing and fifting to the bottom, as often as fuch inveftigation is in our power, opinions, however long eflablilhed, and however generally received ; for many are faid to be confirmed by univerfal expe- rience, yet upon minute and accurate in- quiry, this univerfal experience turns out to be no more than univerfal rumour, found- ed at firft on carelefs obfervation, and after- wards fwelled by falfe and exaggerated fads. But before we adopt any opinion which is to have an immediate influence upon the pradice of medicine, we ought not only to ■weigh and examine thofe fads which we receive from others, but we rnuft alfo be exceedingly careful not to be led into error by thofe which we gather from our own obfervation. It is evident that the firft may lead us into error, becaufe they may be falfe; and unfortunately MEDICAL SKETCHES. 57 unfortunately the fecond, without attention and fagacity, may alfo lead us into error, although they muft be true. A young practitioner orders a courfe of medicines in a particular difeafe,— a rheu- matic complaint we fhall fuppofe ; after this courfe has been continued for fome time, the patient recovers: Well, here is a true fad, from which, if he concludes that the medicines have removed the complaint, he may be in an error. He orders the fame courfe again for the fame complaint; the patient grows worfe. Here is another true fad, handing diredly in oppofition to the former: Well, w T hat does the Dodor conclude now ? After thofe two cafes, if he balances the one by the other, he might infer that the courfe of medicines had juft an equal chance of doing harm or good. But a phyfician will not naturally 5 S MEDICAL SKETCHES. naturally reafon in that manner ; having a partiality for the courfe he has prefcribed, he will molt probably remain perfuaded, that in the firft inftance the medicines per- formed the cure; and in the fecond, fome peculiarity of conftitution counteracted their effeCt, and made the patient worfe. And here he may be wrong again ; the medicines very poffibly may have done neither good nor harm in either cafe, and the different events may have entirely de- pended on certain circumftances, which the practitioner unfortunately overlooked. • » Perhaps a change of wind from eaft to weft in the firft ca r e, and from weft to eaft in the fecond ; or perhaps one patient’s chamber was dry, and the other’s w T as damp. It cannot therefore be too often repeated, that every circumftance muft be w-eighed and attended to with the moft careful cir- cumfpeCtion MEDICAL SKETCHES. 59 cumfpedion during the courfe of our ex- perience, left this very experience confirm us in error. This fhews how very prepofterous it is to put reaforiing in oppofition to experience in the pradice of phyfic, fome degree of theory or reafoning being abfolutely necef- fary to dired our experiments, and after- wards as neceffary to enable us to draw juft conclufions from them, and to apply them, ufefully; not only in cafes in all refpeds fimilar, but alfo in thofe which, differing in fome particulars, ftill have a general analogy. He who derives his medical knowledge from books alone, and whofe exalted no- tions have not been moderated by expe- rience, will pradife medicine as the phi- lofopher who declaimed on the art of war to Hannibal, would have commanded an army; he who has feen much pradice without 60 MEDICAL SKETCHES. without reafoning, as one of Hannibal's pioneers ; and he, who to extenfive ex- v v perience joins the greateft natural acutenefs and all the powers of reafoning, as Hanni- bal himfelf. Yet fome practitioners have been Co much fhocked and aifgufted with the flimfy and fantaftical theories which have been invented as a foundation for rational prac- tice, that' they explode almoft every kind of reafoning in the practice of medicine.— “ We truft, 5 ’ fay they, ec to experience, and “ experience only : We know that Jefuits lood from the vifcera of the lower belly to the liver. fame MEDICAL SKETCHES. 131 fame in all refpe&s with blood returning by the veins from all the other parts of the body. Had the blood in the firft cafe been fenfibly impregnated with urinous, and that of the fecond with bilious particles, it might have been natural to have judged a priori , that urine would be drawn from the one and bile from the other ; but as previoufly to the fecretions, no fuch particles can be found, the matter feems rather darker after the explanation than it was before. As to the afiertion concerning the fpirituous quality of that portion of blood carried by the carotids to the brain, the ar- gument Hands nearly in this way : The blood fent to the brain is more fpirituous and refined than the reft of the mafs. I do not find it fo. Yes, Dut it muftbe fo. Why? . 1 - - C-~ K 2 Becaufe r 3 2 MEDICAL SKETCHES. Becaufe the animal fpirits are fecreted Irom it, and all the world knows that the animal fpirits are the molt refined of all fluids. Where is this fluid ? In the nerves. ■ Cut a large nerve, and fhew it to me. You cannot fee it, it is fo refined. That is. unlucky. On the contrary it is the. moft fortunate thing in* the world y if we *could fee it, it would be good for nothing; but we are fure it is there.-" 31 * 33 ; : How^fb ? 1 i How 'fo? : For what otherymrpofe but the fecretion : of : this' finb setherial fluid would the moft fpirituous part of the blood be fent r ' "~ r * r r . ^ [ by the carotids to the brain? So that it is clear from this "circular demonftration, that the moft refined part of the blood goes tc the brain, becaufe _ the animal fpints are fecreted ; and that the annnax fpirits are fecreted there, becaufe the moft reflned part .of the ’.blood goes to the brain. The MEDICAL SKETCHES. 133 The notion that the mammary arteries of nurfes are more plentifully ftored with chyle than the other arteries of the body, has arifen on no better foundation. The blood of thofe arteries has never been adtually found impregnated with a greater proportion of chyle than that of others; but as on perceiving that the urine, a watery liquor, is fecreted by the kidneys, and the bile an oily one, by the liver, it is concluded that the blood which goes dire£l~ ly to thofe two organs is fuller of watery and bilious particles than the reft of the mafs ; fo on finding that milk, a fluid re- fembling chyle, is fecreted in the breafts of nurfes, it is taken for granted that the blood of their mammary arteries is uncom- monly full of chyle. It would appear indeed, that the chyle is a conftderable time before it changes its na- ture. f :id is aflimilated into the mafs of K 3 blood; 134 - MEDICAL SKETCHES. blood ; for when blood is drawn after a plentiful meal, the ferum is of a whiter colour than ufual, owing in all probability to the frefh abforbed chyle’s not being per- fectly affimilated; but this regards the mafs of blood in general, and not that of the mammary arteries in particular. It is cer- tain however, that when a nurfe is kept too long from food, and her breafts almoft en- tirely drained of milk, what little is found there contains an unufual quantity of fait, and is rejected by the infant with figns of difguft ; yet within three quarters of an hour or an hour after eating a competent quan- tity of frefh broth, her breafts will be re- plenifhed with milk, and the child will luck with fatisfa&ion and avidity. In this cafe the food received into the ftomach, if not the immediate fource of the milk, feems at leaft the caufe of the breafts being filled with that liquor; but the fhortnefs of the internal between the caufe and effect feems fur- prifing, and difficult to be accounted for. W3 MEDICAL SKETCHES. *35 . We cannot fuppofe that this food is di« gelled, converted into chyle, this chyle thrown in the common way into the mafs of blood, and fecreted in the form of milk from the mammary arteries ; for the procefs of digeflion alone mud engrofs much more time than the whole interval in queftion. But even upon the fuppofition that the digeflion could be completed and the chyle formed from the food within that interval, this would not remove the difficulty. Let us confider the journey the chyle has to make before it arrives at the breafts: It is firfl carried into the thoracic duft, thence into the fubclavian vein to be mingled with the blood ; from the fubclavian vein it flows Into the vena cava, paffes through the heart, then through the lungs, returns and paffes again through the heart into the aorta, and is diftributed all over the body, the common proportion only going to the mammary arteries, from whence the chyle is lecreted. When we think on all this, and recoil eft aifo that the chyle falls drop K 4 by 136 medical sketches. by drop into the fubclavian vein, and is mingled in this circuitous courfe with the blood of the whole body, we cannot poflibly conceive that the proportion of chyle form- ed from this fingle meal, which falls to the fhare of the mammary arteries, is the entire fource of this copious flow of milk. Others fuppofe that the broth, without waiting the ufual procefs of digeftion, is abforbed by the ladteals of the nurfe’s ftomach, and carried directly to the thoracic duct, and fo into the blood. But this fuppofition, even if granted, would only cut off the time taken up in digeftion, and leave the other ob- jections in full force. The fact being certain, and all thefe methods of accounting for it unfatisfa&ory, fome have fufpeded that there is a fecret conveyance undetected by anatomifts, by wdiich this nourifhment is fmuggled from the nurfe’s ftomach to her breafts, and there converted into milk without being pre- vioufly either changed into chyle or blood. But MEDICAL SKETCHES. 137 But to this wild hypothefis ftronger ob- jections arife than to any of the preceding. ' It fuppofes a fluid to be fecreted, and not from the blood, which is contrary to the rule obferved by Nature in the other fecre- tions, all of which are formed from the blood, and it renders the mammary arteries almoft entirely ufelefs. When the ftomach is empty, ftiil there is fome milk fecreted, although in fmall quantity and of a bad quality; if there- fore we admit this hypothefls, there muft be two ways of fecreting milk, one directly, from the .nourifhment in the ftomach, and the other, when no nourifhment is in the ftomach, 'from the blood in the mam- mary arteries. And finally, to fuppofe a diredt paflage from the ftomach to the breafts unobferved by anatomifts, implies a degree of careleff- nefs and want of attention, which ill ac- cords with that fpirit of minute inveftiga- tion 1 38 MEDICAL SKETCHES. tion and ardour for difcovery, by which this clafs of men are peculiarly diftinguifhed. A fudden and profufe fecretion of milk, after all, is not more difficult to be account- ed for than the fudden and profufe fecretion of tears which in fome people attends pain and grief, or than the great augmentation of fome other fecretions from various exciting caufes. What is fingular in the inftance of milk, and occafions the peculiar difficulty, is, that its augmented fecretion fo immediately follows eating, that we are tempted to think, in fpite ofreafon and anatomy, that it is the identical food received in the ftomach, which in lefs than an hour after flows from the nurfe’s breafts in the form of milk. — Difficulties unqueftionably attend every ex- planation that has been given of this pheno- menon. The following feerns liable to the feweft, is the molt fimple, and I imagine the moft probable. When MEDICAL SKETCHES. 139 When the nurfe is faint from hunger, her circulation, as that of every perfon in the fame hate muft be, is languid, and of courfe all the fecretions are diminifhed ; but after fhe has received a fufficient quantity of nourifhing liquid food, it ijiftantly ads as a ftimulating cordial to the nerves of the flomach, with which all the nerves of the body have a wonderful fympathy; the cir- culation is quickened, every fecretion is in Tome degree encreafed, part of the food is abforbed and carried into the circulation foon after it is fwallowed, which caufes a general fulnefs of the blood- veffels ; the mammary arteries enlarge and carry blood more rapidly and in greater quantities to the breafcs; they are ftimulated to fecrete more in proportion than other glands, and thus the breafts of an exhaufted nurfe are filed with milk foon after a nourifhing and reftorative meal. A glafs of wine in fome meafure has the fame effed ; it gives the cordial ftimulus to the r 4 o MEDICAL SKETCHES. the nerves of the ftomach, increafes the cir- culation, and promotes fecretion, but it does not keep up the fecretion by pouring frefh juices into the blood. The effects of the wine decreafe every moment after the firffc exertion of the conflitutional powers it ex- cites: The effects of a nourifhing meal are more copious and permanent. If however it is afked, how this ftimulus is given to the breafts in. particular, or why a plentiful meal fhould be followed by a flow of milk, rather than of any other of the fecreted juices, no fatisfa&ory anfwer can be given, more than if it were afked why the breafts of women fecrete milk after labour, and not before. We fee the beft reafons why it fhould be fo, although we cannot difcover by what means it is brought about ; we muft not attempt to explain final caufes. To return to the fubjeft of fecretion : In whatever way the fecreted fluids are fepa- rated MEDICAL SKETCHES rated from the blood, or however their com- ponent particles are combined, it is certain that the fecretion of fome of thofe fluids is performed with, and in others without, the mediation of certain fubftances 'called glands. . • ■ T ‘ - '' The faliva, tears, bile, femen,~. urine, and fome other fluids, are of the firft clafs ; the lymph and the fluid thrown out of the body by fenfible and infenfible perfpiration, of the fecond. Thefe laft, as has been generally thought, are fecreted from the blood without the aid of glands, and merely by the mechanifm above defcribed, of fmaller veffels branching from larger ones, and draining a thinner from a thicker liquor. The former are feparated by the inter- vention of glandular fubftances of one kind or other; for we always find fiich fubftances at the places where thofe fecretions are formed. 142 MEDICAL SKETCHES. 1 formed. We can fee the fecreted fluid flow- ing from them by a pipe called the excre- tory du6t ; we know that the gently touching or prefling certain glands promotes the fecretion ; and we know that when the glands are obftru&ed, or deftroyed by dif- eafe, or entirely cut from the body, the fecretion no longer takes place ; fo that there can be no fhadow of' doubt that glands are the agents of the fecretion of the fluids in queftion. A gland then is a fubftance contrived for the purpofe of feparating fome particular liquor from the blood; it is generally of a fmooth furface, and feparated from the ad- jacent parts by a fine membranous coat, ’ which admits an artery and nerve to enter, and a vein to iflue, along with a canal called the excretory du ed in a particular manner, occafions maraf» * Yet fome very minute anatomifts have afierted, that a white fluid is found in the cellular fubftance of the lym- phatic glands of young animals, but not in thofe of old : They add, that this fluid is globular, and of a courfe dif- ferent from the lymph. It may be conjeftured therefore, that the ufe of the glands is to feparate this fluid ; but as this fluid, whatever is its ufe, makes no apparent change on the lymph, which ifiues out of the glands as pellucid as it entered, and as it is not found in old animals, the whole remains in as great obfcurity as before the difcovery of the white whole fluid. N mus i % 8 Medical sketches. tnus* and other complaints: This how- ever is only a ftrong inftance of the limited tiature of our faculties. The admirable mechanifm of Nature in general, difplayed in ten thoufand aftonifhing examples, and the exquifite wifdom with which every part is adapted to its peculiar ufe, in the human frame in particular, leaves us no room to doubt, that thofe numerous glands ferve fome effential purpofe, although this has hitherto efcaped the refearches of phy- fiologifts. What confirms this idea, if a thing fo obvious required confirmation, is, that in proportion as the fpirit of fcrutinizing nature has advanced among mankind, new proofs have appeared of the infinite intelli- gence of its Author in the arrangement of all its parts ; and fome have been difcover- ed to be effential, which were formerly thought fuperfiuous. * Marafmus. A particular kind of confumption. MEDICAL SKETCHES. 179 Vlv RESPIRATION. digeftion of our food, the circu- lation of the blood, fecretion, and ab- sorption, though all eflential to life, yet are not fufficient to preferve it even a few minutes, without the conftant flowing of frefh air into the lungs, and its reflux back to the atmofphere. The firfl: is called in- fpiration, the fecond expiration, — both re- fpiration. The thorax or cheft in which the lungs are lodged, is compofed of bones, cartilages, and mufcles, fo artfully arranged, that its cavity may be confiderably enlarged or di- miniflied at pleafure. This is brought about, partly by the elevation of the ribs, N 2 and x8o MEDICAL SKETCHES. and partly by the pulling down of the diaphragm or mufcular partition, that divides the cheft from the lower belly. This partition naturally bulges convexly upwards, fo as to encroach confiderably on the cavity of the thorax ; but on infpira- tion, it is pulled downwards from its con- vex to nearly a plain furface, and thus gives a fpace to the cheft, which it takes from the lower belly. The cavity of the cheft therefore may be enlarged in two different directions, — by the elevation of the ribs it becomes wider, by the depreffion of the diaphragm it be- comes deeper. \ • The external air has accefs to the lungs by the trachea or wind-pipe; the upper- moft part of which, called the larynx, opens into the throat, by an aperture called the glottis, and communicates with the atmofphere by the mouth and noftrils. The MEDICAL SKETCHES. i2t The trachea is a flexible pipe, compofed of a feries of cartilaginous rings, joined by mufcular fibres, and lined with a mem- brane. This tube, defcending from the throat into the lungs, divides and ramefies in com- pany with the numerous branches of the pulmonary artery, and with them and the veins forms that fpungy fubftance called the lungs. The pulmonary artery terminates In the pulmonary vein; but the branches of the trachea end in fmall membranous cells or bladders; fo that there is not a circulation of air through the lungs, as there is of blood. For the blood rufhes in by one fet of veflels (arteries), and returns by another fet of veffels (veins) ; whereas the air, rufhing in by the trachea, flowing through all its ramifications, and extending to its moft re- mote cells, returns to the atmofphere by the N 3 fame 1 82 MEDICAL SKET CHES. fame way it entered. The organs concern- ed in this are partly adtive, and part- ly paflive. The intercoftal mufcles and diaphragm are of the firft kind, the lungs , themfdves of the fecond. When the intercoftal mufcles elevate the cheft, which the crofs direction of their fibres, and the peculiar articulation of the ribs, admirably enable them to do ; and when the diaphragm is drawn downwards, the cavity of the thorax is enlarged, and the air within the lungs expanded, in pro- portion to the acquired fpace. This air, of courfe, becomes rarer and fpecifically lighter than it was before. But it was then in equilibrio with the atmofphere ; and this equilibrium be- ing now removed by the expanfion, the external air enters the larynx, and flows through all the branches of the trachea, re- ftoring the balance between the ambient air and that in the lungs, Whether I MEDICAL SKETCHES. 183 Whether the cheft is fwelled by infpira- tion, or depreffed by expiration, the lungs fill exa&ly the whole cavity, and are always in contact with the pleura, which is the name of the membrane that lines the in- ternal furface of the thorax ; no air being permitted between this membrane and the external furface of the lungs, for if there was, the lungs could not polfibly play, as this air would counterbalance the prelfure of the atmofphere. So many organs being fubfervient to refpiration, and this important function being performed by the means of filch curious and complicated mechanifm, we need not be furprifed to find that various attempts have been made to explain the immediate caufe that excites this fun&ion. We are told of the compreffion of certain nerves, the interruption of certain fecre- tions, the ftimulus given the lungs by the blood rufhing into the pulmonary artery, N 4 tfie 1 84 MEDICAL SKETCHES. the alternate contraction of antagomft muf- cles, thofe of infpiration relaxing thofe of expiration, &c. &c. ; but, after all, the matter remains unexplained to this day, unlefs what follows can be confidered as an explanation ; for when ftripped of improbable conjecture, oftentatious and technical terms, and fuperfluous language, the volumes that have been written on the fubjeCt amount to this : We have a fenfation which excites us to expand our cheft, the action accompanies the inclination, and the air flows into the lungs; — when enough is admitted to anfwer the purpofes of health, we feel an equal defire of expelling it, which is direCtly fol- lowed by the accomplifhment of our defire; and thofe alternate feelings are conftantly renewed and gratified, with or without reflexion, afleep as well as awake, while life lafts. A peafant would have faid it in ftill fewer words- — “ We breathe in confequence is of its being in our power ; and becaufe 4 ‘ pain MEDICAL SKETCHES. 185 this however is not fully afcertained. The brain itfelf appears fuch a grofs inert mafs of matter, that perhaps there is no organ of the human body that we- fhould have lefs fufpeded of being connected with thought. But although we can form no idea how this connedion fubfills, or by what means the nerves are the organs of fenfation and motion, yet we cannot have any doubt of their being both. The circumflances which lead us to this opinion, and confirm us in it, are curious in themfelves j and a knowledge of them is ufeful in the pradice of medicine. We are led to conclude that the brain is the feat of thought, 7 Firft, 204 MEDICAL SKETCHES Firft, from a feeling we all have, that imagination, memory, judgment, and all the faculties of our minds, are exercifed within the head ; the cavity of which is completely filled with brain. Secondly, Becaufe a long exertion of thought is as apt to create a head-ach, as an exceflive exertion of the arms or legs is to produce uneafinefs in thofe members. Thirdly, Becaufe the nerves, which ferve four of our' five fenfes, the fmell, the tafte, the fight, and the hearing, take their origin direClly from the brain; and thofe which do not, take it indirectly by the intervention of the fpinal marrow. Fourthly, Becaufe whatever deflroys the nerves belonging to any organ, effectually deprives us of the ufe of that organ. An obftruction in the optic nerve, for example, produces complete blindnefs, although the vifible parts of the eyes remain perfectly found. Fifthly, MEDICAL SKETCHES. 20J Fifthly, Becaufe the cutting or tying a nerve, going to any particular limb, de- ftroys all fenfation and power of motion in the part below the fedion or ligature. Sixthly, Becaufe a diflocation of the ver~ tebrs of the loins, by which the fpinal marrow is comprelfed, numbs the fenfation of the lower extremities, and renders them paralytic. Seventhly, Becaufe cutting quite through the fpinal marrow at the vertebrae of the neck, deftroys all nervous communication between the head and the body; the vital motions of refpiration, and the circulation of the blood mult ceafe, and of courfe the perfon dies*. Finding that when the nerves going from the brain or fpinal marrow, to any part of the body are deftroyed, the fenfation and * It is evident, from the caufe afligned above, that death muft foon enfue, — but the perfon dies inftantly, the reafon of which is not fo clear. powers 2 Q 6 medical sketches. powers of that part are alfo deftroyed ; we might naturally infer, that when the fub- ftance of the brain itfelf is injured, its functions would be impaired. We accordingly find, that this in fact is the cafe, and that the functions of the brain are impaired in proportion to the injury. A wound or difeafe, which efientially deftroys the organization of the brain, im- mediately deftroys thought and fenfation, the perfon inftantly dies. Whatever confines or injures the brain, difturbs thought. A blow on the head has rendered a man of acutenefs ftupid during the remainder of his fife. A bad conformation of the fkull, or feme difeafe in the fubftance of the brain, are among the caufes of ideotifm. The brains of madmen are generally found of an unnatural hardnefs or weight. A fmall MEDICAL SKETCHES. 2o 7 A fmall preffure of the brain diminifhes, a ffronger deftroys the fenfibility of the whole body. When part of the fkull has been beat in, fo as to occafion a compreflion of the brain, without injuring it otherwife, the patient continues in a ftate of drowfinefs or perfect infenfibility j let the fkull be raifed by the furgeon’s art, and the preffure removed, the patient gradually awakes, as if from a deep fleep, and regains the exerciie of his under- handing. There was, fome years fince, a beggar at Paris, a confiderable part of whofe fkull had been removed without injuring the brain, in confequence of a wound. This being healed, he wore a plate upon the part where the fkull was wanting, to prevent the brain from being hurt by every accidental touch. For a fmall piece of money this poor -creature took off the plate, and allowed the brain to be gently preffed, by laying a hand- kerchief, 20§ medical sketches. kerchief, or fome fuch foit fubftance upon it ; this immediately occafioned dimnefs of fight and drowfmefs; the preffure being fomewhat augmented, he became quite in- fenfible with high breathing, and every fymptom of a perfon in an apoplexy ; from which ftate he never failed foon to recover, upon the preffure being removed. As this experiment was attended with no pain, it was often repeated, and always with the fame effedt. From thefe obfervations it feems evident, that the brain is the feat of thought ; and that a communication is kept up, by the inter- vention of the nerves, between this fenfo- rium and all the parts of the body. In preferving this communication, the nerves perform two diftindt offices. One is, conveying fenfation from all parts of the body to the brain : Whatever im- preffion is made, whether of an agreeable or dif- 209 MEDICAL SKETCHES. dilagreeable nature on any part of the body, immediate intelligence of it is con- veyed by thofe faithful centinels, to the feat of reafon. The other office performed by the nerves, is carrying the commands of the will from that feat to all the different parts of the body ; in confequence of which the limbs and body are moved, in a great variety of directions, as the will ordains. For viojl of the mufcles of the body which produce motion, are in the guidance of our will ; lome of them, however, are entirely inde- pendent of it, as thofe of the heart and veffels which carry on, the circulation of the blood ; and fome are partly under the di- rection of our will, and partly independent of it, as thofe of refpiration. But all mufcles, the involuntary as well as the voluntary, are enabled to aCt, only by their communication with the brain; P for 210 MEDICAL SKETCHES. for when that is cut off by the deftnnftioii of the connecting nerve, whatever im~ prefhon is made on the part, can no longer be felt ; the orders of the will to that part can no longer be obeyed, and the part itfelf can no longer move, or at leaft it can move only for a fhort time, by a power of a pe- culiar nature, belonging to mufcular fibres, which fhall be mentioned more particularly hereafter. As nerves are difperfed to almoft every part of the body, almoft every part of the body is endowed with feeling, but in very different proportions ; fome parts having a much more delicate feniation than others. The bones, cartilages, ligaments, and tendons, in a found ftate, feem infenfible. — Nerves have been traced into bones ; I be- lieve none have yet been difcovered going dire&Iy into the cartilages, ligaments, or tendons. We MEDICAL SKETCHES. an We have no doubt, however, of theft?* being furnifhed with them alfo, becaufe in particular fituations they have fenfibility. The bones and other parts of little or no fenfibility when in a found ftate, are fub- jeft to very acute and permanent pain in a ftate of inflammation : We know this by the effects of the venereal difeafe, of the rheu- rnatifm, and of the gout. A prodigious quantity of nervous fila- ments is difperfed to the (kin, and minutely interwoven with its fubftance; the feeling of this tegument therefore is exquifite, and were it not covered and blunted by the infenfible cuticle or fkarf {kin, the com- moneft a&ions of our lives would be infup- portable ; but having this thin and infen- fible membrane admirably fpread over every part of it, the clothes and other fubftances which neceffarily come in contact with the body, give no pain, and many feelings are P 2 rendered 212 MEDICAL SKETCHES. rendered indifferent or pleafmg, which otherwife would have been agonizing. The only parts of the body that feem to be entirely and in every ftate infenfible, are the hair, the nails, the fkarf fkin, and per- haps the enamel of the teeth. As the hrfl tw T o often require to be cut, it would have been unfortunate for man- kind if they had been endowed with feeling. The perfect infenfibility of the cuticle protedls us from the torture which every movement of the body would otherwife have occafioned, while its thinnefs permits that degree of fenfation that is neceffary for warning us to avoid the fhock of de- flructive fubftances ; and in a thoufand in- stances conduces to our fafetv, our eafe, and our pleafure. ■ The enamel, in fome meafure, performs the fame good office to the lofter bony part of the teeth, that the cuticle does to the fkin ; MEDICAL SKETCHES. 213 ikin ; the wirdom and benevolence of the Author of Nature being equally conspicuous in the formation of thofe parts, which are deprived of all feeling, as in thofe which convey the moft agreeable fenfations. It has been already obferved, that four of our five fenfes are confined to the head ; each of thefe four have organs exquifitely formed for their ufes, with proper receptacles adapt- ed to their nature, contrived for their con- venience and protection; and there alone their functions are exercifedo The fifth fenfe, that of feeling, belongs to the Mmole body, but is moft accurately exercifed by the hands. Many of the brute creation enjoy the organs of the fenfes in common with man, and poftefs fome of the fenfes, particularly that of fmelling, in greater perfection than any of the human race ; but the touch they certainly have in a far inferior degree : For P 3 befides 214 MEDICAL SKETCHES, betides the more perfect fenfation that man mutt have all over the body, from the deli- cacy of the fkarf fldn; the make and fal- libility of his hands render his touch in- finitely more accurate than that of any animal. There is certainly nothing in the external form of man, which gives him fo many advantages over other animals, as the admirable mechanifm of his hands. It has been remarked, that even brutes are intelligent in proportion to the accuracy of their feeling, or as their extremities ap- proach in refemblance to the human hand. The horfe and the bull, whole feet are covered with callous hoofs, are lets intelli- gent than the dog, and the dog is inferior in acutenefs to the ape, who has a rude kind of hand. Independent of other more important advantages, the fuperiority which the won- derful contrivance of this member gives to man, MEDICAL SKETCHES. 215 jtjjan, is prodigious : By the variety of its motion in all diredions ; by its divifion into fingers, and by their flexibility, it is enabled jo ply round every fubftance ; b^ the ex- adnefs of its touch, to convey a juft notion of every form ; by its ftrength, it enables man to rear fabrics to eonveniency, to mag- nificence, and to devotion ; by its dexterity, to imprint upon ftone and upon canvas, the molt beautiful imitations of nature, and the fublime conceptions of genius; and by its united powers, to form and wield wea- pons more formidable, than the paw of the Hon, or the probofcis of the elephant. It cannot be denied, however, that with •i the external fenfes, many of the brute creation are endowed, in common with man, with feveral faculties of a more refined nature. Some people, whether from a high opinion of other animals, or a humble one pf human nature, I fhall not take upon me to fay, have ftruggled hard to bring the one P 4 as 216 medical sketches. as near to the other as they could, or pqt them quite upon a level, if poffible. By thofe advocates for the brute creation we are told, that they are actuated by the paffions of fear, of grief, of joy, of anger, and of jealoufy, as well as men; that they poffefs the virtues of fidelity and gratitude in a higher degree. That the greateft heroes have not fur- paffed them in courage ; that they even dis- play that quality, independent of any ad- vantage to be acquired, and from no appa- rent mqtive, but a generous fpirit cf emula- tion, and a difdain of turning their backs upon danger. That they affectionately tend, and care- fully provide for their young; and with a prudent attention to their own future wel- fare, they prepare for the fcarcityof winter, by carefully heaping up provifions during the abundance of fummer. That MEDICAL SKETCHES. 217 That to avoid the inconveniencies and feverity of northern winters, they crofs vaft deferts and feas in fearch of more genial climes ; and prompted by a predilection, a patriotic attachment, they return at the approach of fummer to their native country. That they uniformly follow that plan of life which is moll fuitable to their refpedtive natures, and never, milled by vain hopes and fantaftic defires, deviate, like man, into the paths which lead to mifery and remorfe. That they are not obliged, as men are, to fearch after remedies for their diflempers, by dangerous trials and laborious experience, nor to truft the care of their healths to a combination of felfifh mercenaries ; but when by accident they are lick, which is feldom the cafe, they find their cure at once, by an intuitive faculty, without any trouble, After M EPICAL SKETCHES. gi3 Alter having admitted, in its fulleft ex- tent, every fair companion that can be made between man and the moll perfect of the other animals, acknowledging that both have bodies of matter organized in many j-efpedts alike ; that the bodies of both are made up of bones, mufcles, and blood- yelfels, organs of refpiration, circulation, and digeltion ; that both have brain and nerves apparently of the fame fubftance and texture ; that in both, thofe are the organs of will, of fenfation, and of motion ; that both polfels five fenfes of the fame nature, and have a refemblance in many of their appetites and inclinations.; after all thofe concelfions, the internal faculties of the moll intelligent of the brute creation will be found, upon a juft eftimation, at a prodi- gious diftance beneath thofe of men. The actions of the one feeming to pro- ceed from the impulfe of fome want, the incitement of fome appetite, or fome con- ■ >'> 6 ' trolling 219 - MEDICAL SKETCHES, trolling fpring within them, which obliges them to perform the fame thing in the fame manner; all their boafted works, the la- bours of every fpecies, and of every indi- vidual of the fpecies, are as uniform as if they had been all caft in the fame mould, This appears in their nefts, in their cells, in the labours of the ant, the bee, and the beaver ; all their works are formed by an invariable accumulation, a necejffary attrac- tion and depofition of matter, like the growing of a plant or the cryftallization of a fait. One race of the mod; intelligent fpecies never improves upon a former, nor one in- dividual upon another. At the end of the elephant’s long life, what does he know that he did not know at the bepinnkwr ? What does the young elephant learn from the experience of his father ? There is no ana of greater b right nefs than another in the hidory of any animal but man ; 220 MEDICAL SKETCHES. man ; all, from the earlieft records of time to the prefent moment, is one uniform period of far greater darknefs than any re- corded in the annals of mankind. And if it is urged that there may have been fome unrecorded sera of human fociety wherein men were in a hate of equal dark- nefs, it muff be allowed that they have emerged out of it, which equally proves the great fuperiority of their nature. Speech, that wonderful faculty by which men convey to each other every emotion of their heart and every idea of their mind, is natural to all the human race, even to the mod: uncultivated negro and favage, but is unknown to the wifeft of all other animals. Is this owing to a defeat in the organs of fpeech l No. In fome animals thofe organs feem fufficiently capable of it, and fome have been taught to pronounce fentences, but none to underhand what they pro- nounced ; for language implies a chain of connected MEDICAL SKETCHES. 221 connected ideas fuperior to what any animal but man feems able to attain. How comes it, that with fo much fagacity and reflexion as fome people contend certain animals pofTefs, the ftrongeft and the fhrewdeft among them have not made the weaker and lefs intelligent fub- fervient to their ufe ? How comes it, that the mod uncultivated of the human fpecies have from the beginning of time made the mod powerful and knowing of the brute creation fubfervient to theirs ? If by his ex- ternal form man has fome advantages over them, by forming an alliance they might foon overbalance this, and free themfelves from fubjeflion. What human force could Hand againft an allied army of lions, ele- phants, and eagles, if they had judgment to ufe their fuperior powers ? Even attention “to their young, the moft univerfal and moft amiable part of the character 222 MEDICAL SKETCHES. character of irrational animals, feems inde- pendent of fentiment and reflection, and to proceed from the blind impulfe which prompts them to the choice of plants in llcknefs, to accumulate pfovifions, and build cells ; for after a fhort period thofe young are entirely neglefted, and no trace of affedtion, or the fmalleft tender recollec- tion, feems any longer to fubfift between the parent and the child. How different is this from the fenfations of the human fpecies, where the father and mother feel their youth reftored, and their exiftence multiplied in their children, whom they endeavour to turn from the allure- ments of folly, and by creating in their minds a defire of knowledge and ufeful attainments, they fave from the wretchednefs of vacancy, and the contempt attendant upon ignorance ; who encourage their exertions, fupport them under difappointment, whofe chief Medjcal sketches. a*j chief happinefs depends on the profperity of their offspring, and who feel the approach of age without fadnefs, while the evening of their lives is brightened by the riling reputation of their children. Notwithftanding the analogy which has been pointed out in the ffruCture of ani- mals, which is thought to be continued by a gradual and almoft unbroken chain of conne&ion from man down to the moft in- fenfible of the animal world, and from thence carried equally entire through the vegetable, this analogy is in the bodily ftruc- ture only ; for when we turn our reflections to the reafoning faculties of man, and the endowments of the human foul, the diftance between this and the higheft intelligence of any other animal is infinite. The only advantage that other animals can be fuppofed to have over man is, that being excluded by their nature from all mental MEDICAL SKETCHES. c 224, mental enjoyments, they are alfo fecured from all the pains and difquietudes that pro- ceed from the fame fource ; but to acquire an exemption from difquietude at the expence of being equally exempted from all the de- licate feelings of the mind and affe&ions of the heart, is a purchafe which I hope no honeft mind will ever be willing to make. An ingenious lady, in a celebrated * Ode, feems, however, defirous of the exchange ; but the moll fcrupulous obfervers of truth on other occafions, are permitted to be in- fincere in poetry. If this indulgence is granted in proportion to the poetic talent difplayed, few people have a right to fo great a fhare as this lady. It was obferved above, that as often as an impreffion is made upon any part of the body, a fenfation proportionable to the force of the impreffion and to the fenfibility of the part is inftantly carried by the nerves to * Ode to Indifference, by Mrs. Greville. 5 the MEDICAL SKETCHES. 22s the brain, and our attention is dire&ly called to the part affeTed. But it fometimes happens that when the impreffion is really made upon one part, the fenfation is perceived as if it were alto- gether, or in the greateft degree, in another, at perhaps a confiderable diftance. Thus an affection of the liver often occa- fions a pain in the right fhoulder. This ciftfumftance of one part feeling when another is injured, being limilar to the concern which a perfon of humanity takes in the diftrefles of his fellow-creatures, has procured it the name of fympathy. There are fome particular impreffions which occafion an almolt univerfal fympathy all over the body. Cold water thrown upon a warm part of the body produces a fudden contra&ion of all the external fibres. Tickling the foies of the feet will throw almoft the whole mufcles of the body of many people into convulfions. CL A glafs .226 MEDICAL SKETCHES. A glafs of wine or of brandy received into the ftomach of a perfon exhaufted with fatigue and ready to faint, gites inftanta- neous fpirits and frefn vigour : This muft proceed from the maimer it affeds the nerves of the ftomach, and their being fympathifed with, by the reft of the body, as there is not time for the liquor being conveyed into the blood in the ufual manner. When a fever arifes in confequence of a wound, or of any local affedion, it muft be owing to the fympathy between the part affected and the conftitution in general. There are certain parts of fo much im- portance to life that they cannot be affeded, even in a moderate degree, without occa- fioning a general fympathy, or in other words, difturbing the whole conftitution ; fuel* are, the brain, ftomach, and vital organs. But even the leaft important parts of the body endowed with fenfibility, when they are t MEDICAL SKETCHES. 227 are violently affected, produce alfo univerfal fympathy : Thus a fevere toothach occa- fions a confiderable degree of fever. Worms irritating the nerves of the in- teftines fometimes occafion fever, fome- times convulfions, and often itching in the noftrils. The teething of infants often produces purging and fever, and fometimes con- vulfions. Befides the general fympathy of the con« ftitution with certain parts of the body, there are alfo many particular fympathies between two particular parts. A difeafe of the liver producing pain in the right fhoulder has been already men- tioned. Any thing irritating the kidneys, fand for example palling from thence to the bladder, oceafions a vomiting. A rough: Hone in the bladder produces a pain at the end of the urethra, CL* The 228 MEDICAL SKETCHES. The ftomach not only is more univer- Tally fympathifed with than other organs, but alfo has a greater number of diftindt reciprocal fympathies with particular parts ©f the body, than any other organ. A blow on the head occafions vomiting. A difordered ftomach often excites a headach. The headach "which is apt to come after drinking too mu.ch wine or other ftrong liquors, certainly proceeds from the ftomach, and fometimes is diminifhed or entirely removed by a dram. The tremor or lhaking in the hands to which habitual drunkards are fubjeCt, is palliated by the fame iniidious remedy. A difordered ftomach with indigeftion, is often accompanied with flufhings in the face, with palpitations at the heart, with in- termitting pulie, with difficult breathing, with deje&ion of fpirits, with an uncom- ‘xnon fenftbility to any unexpected fight or noife, and with giddinefs. The 229 MEDICAL SKETCHES. The fight or fmell of grateful' food pro- duces an augmented how of faliva. Whatever produces a naufea has the fame effed. . A draught of very cold water, or eating iced creams, gives a pain in the nofe near the forehead. Harfh founds affed the teeth. Eunuchs have no beards ; and theif Voices are different from thofe of other men ; This fhews a fympathy between * remote parts, which no anatomifts could have fufpeded, from communication of nerves or otherwife. A mutual fympathy is obfervable not only between different parts of the fame body, but our bodies are alfo affeded by the impreffion which various things uncon- nected with them make upon our minds. Some people faint at the fight of blood, even when it is made to flow from the vein of another, on account of his health. 0w3 Others 2 3 o MEDICAL SKETCHES. Others complain of an uneafy fenfation in their own eyes, on looking ftedfaftly at the inflamed eyes of another perfon. Every fentiment of the mind has parti- cular parts of the body in correfpondence with it, and affedted by it. A ridiculous fcene pafling before the eyes, or even recounted to us, throws us into a convulfion of laughter. ; 1 ■ 1 - lj t - - - •' la the fame manner an affecting fcene, or an affedfing ftory, excite the fundtion of the lachrymal glards, and we fhed tears, - Any inftance of great oppreflion or in- juftice which we fee or hear of, produces inftant marks of indignation in our coun- tenances. If we ourfelves are the objedls of injuflice t)r infults, anger and rage will be very apparent in the mufcles of our face. A folemn or awful fcene naturally ccm- pofes the countenances of the fpedfators into an uniform folemnity of features. l * * - Hatred, MEDICAL SKETCHES. 231 Hatred, fcorn, love, fufpicion, confi- dence, admiration, and every other paflion or emotion of the mind, have particular mufcles in fympathy with them, and affedt the features in a particular manner. So that in remote villages, and in thofe coun- tries where the emotions of the heart are not attempted to be concealed or difguifed, it is an eafy matter to know the ftate of men’s minds by looking in their faces. But in more artificial fociety, in great cities and in courts, where many are ffruggling for the fame objedt, where there is an everlaft- ing rivalfhip and jarring of intereft, where men are anxious to conceal their defigns and their wifhes, and dare not avow the real motives of their actions, it is difficult to judge of the feelings of the heart by what appears in the countenance ; yet in the midft of all this affectation and difguife, men of experience and penetration will often fee real joy through artificial tears, genuine fadnefs in affumed gaiety, and in- Q 4- veterate 1 232 MEDICAL SKETCHES. veterate hatred lurking under all the offici- ous fmiling difplay of kindnefs. Art cannot long carry on a fuccefsful war with nature ; men cannot be always on their guard, or keep their features in ever- lafting conftraint ; the genuine paffion will occafionally fhew itfelf in the countenance by the fympathifmg mufcles; the hypo- crite is that inftant detefled, and all his future grimaces are in vain. Thefe laft examples are the natural expreffions of the paffions, and perhaps cannot with ftrict propriety be given as inftances of fympathy. But, independent of the paffions and affections of our own minds, the mere ex- preffions of them in the features of others is apt to produce an imitation of thefe ex- preffions in our own features. There feems to be fuch a degree of fen- fibility or fympathy in the mufcles of the human face, that they fpontaneoufly give an expreffion correfpondent with what we be- hold MEDICAL SKETCHES. 233 hold in the features of another perfon, even although we are ignorant of the caufe which excites it. One perfon yawning will prompt others to yawn almoft as effectually as a long piece of good advice or a dull ftory. At the accidental fight of people in grief or joy, though we are perfect ftrangers to them, know nothing of the caufe of their emotion, and are not at that moment in the fame circle with them ; our features, in- fenfibly as we look at them, affume the ap- pearance of grief or joy, provided we have no particular reafon to controul them. I have feen one eleCtric glance from Mrs. Siddons transfer horror into the faces of a whole audience, even of thofe who had juft arrived, and were in no degree previoufly affeCted by the cunning of the fcene. AffeCtions of the mind not only produce tranfient expreflions of fympathy in the features of the countenance; but when they a 3 + MEDICAL SKETCHES. they are exceflive, or when the confutation of the perfon affeded is weakly, they have been known to flop the fprings of life alto- gether, or fubjed the conftitution to fome permanent difeafe. The unexpeded fight of an objed of horror is one of the caufes of epilepfy, and is faid to be particularly apt to prove fo, when the horror is raifed by feeing a perfon under the convulfive contortions of this difeafe. That all fympathies between different parts of the body are owing to the nerves, is in the higheft degree probable ; but how they are carried on, we have no clear idea; it is in vain to attempt to account for it by he communication of the nerves with each other, or by any nervous communication between the fympathifing organs; for each nervous filament is diflind from all the reft the whole way from its origin to its termf- nation ; MEDICAL SKETCHES. 23s nation ; and there is a ftriking fympathy between many parts, which have no com- munication by means of nerves with each other, as in the instance above mentioned of eunuchs. Befides, when we do trace a communica- tion by nerves between any organ and a part with which it fympathifes, we cannot impute the fympathy to this communica- tion ; becaufe we fometimes find that the fame organ has an equal communication by nerves 'with fome other parts with which it has no fympathy. As it is evident therefore, that various affe&ions of the mind, excited by external objects, produce extraordinary motions, and other effects on the body, merely by affect- ing the brain; and as the confent and fympathy between different parts inflantly ceafe, when their communication with the nerves is interrupted, it feems natural to conclude, i 3 6 MEDICAL SKETCHES. conclude, that all fympathy takes place through the intervention of the brain. f What happens in the epilepfy or falling ficknefs, will contribute to illuftrate and confirm this opinion. In the epilepfy the fit begins by the perion’s falling down in a date of complete infenfibility, and imme- diately after, his whole mufcular fyftem is agitated with violent convulfions, the muf- cles of the face and eyes in particular being frightfully moved and diftorted, the tongue is forrietimes thruft between the teeth, and if care is not taken to guard againft it, it will be bit through by the convulfive {hut- ting of the jaws. The caufe of this difeafe is an afFedion of the brain of fome kind or other. It may happen by the dired ftimulus of an inftru- ment, fplinter, or other extraneous fub- ftance; by whatever impels the blood with violence, and in unufual quantity to the brain ; MEDICAL SKETCHES. 237 brain ; as a fit of anger, intoxication, vio- lent exercife in a warm fun ; it may alfo be occafioned, as has been already remarked* by a fudden fright, the unexpected fight of an objeCt of horror; particularly that of a perfon under a fit of the fame difeafe. In the cafes above enumerated, the brain it” felf is direCtly and immediately attacked, whether the irritating caufe be mental or corporeal ; but the difeafe is alfo produced by ftimulants, which aCt immediately and direCtly upon fome diftant part, and the im- preffion is transferred to the brain by the nerves, as in the inftances of the teething of infants, of worms, or-fomething acrimonious in the alimentary canal, calculi'* in the kidneys, and finally, by what is called the aura epileptics . This is a fenfation which fome epileptics have, previous to every fit : fome defcribe it like * Stones. 238 MEDICAL SKETCHES. like a current of frefh air flowing (lowly, others like an inledt moving or creeping upwards from the extremities or lower parts of the body to the head, where it no fooner arrives than the patient becomes infenfible, and falls into an epileptic fit. But none of thofe irritating caufes which begin by an attack elfewhere, and not upon the brain, are ever found to produce a pain, convulfive motion, or affection of any kind in any of thofe parts with which they have a communication by the nerves ; and may be fuppofed to have a fympathy, until the flimulus has, in the firfl place, been convey- ed to the fenforium or brain. This appears evident, becaufe the patient becomes infenfible in the firfl; place, and the convulfions happen afterwards : Whereas if there was a fympathy between the different parts by means of the nerves independent of the brain, we fhould certainly fometimes fee convuliions in the ftimulated parts themfelves, / MEDICAL SKETCHES. 239 themfelves, and in thofe with which they fympathife, previous to the brain’s being affedted. The firft fenfation of the aura epileptica is generally felt at one particular point ; fome- times a tumour or fome other external mark of diforder indicates the place ; but at other times we can perceive nothing of that nature, and fo far from affe&ing any other part with which it may have a ner- vous communication by fympathy, we fometimes can only prefume there is fome diforder in that part, from the circumftance of the aura s beginning there. It feems very remarkable, that the difeafe may be radically cured by cutting out, or otherwife deftroying the part ; when this cannot be fafely done, or is not fubmitted to, the fit may be prevented by a ligature applied above the part where the aura arifes. And 2 4 0 MEDICAL SKETCHES. And when that dreadful difeafe, the teta- nus or locked-jaw, arifes, from the injuring a nerve by pun&ure or any external vio- lence, although the difeafe fhould not ap- pear for many days after the injury is re- ceived, and when the wound feems almoft healed up; yet even then, the moll effe&ual means of preventing impending death, is, by entirely amputating the part, or at lead cutting through the nerves belonging to it, and fo deftroying its communication with the brain or fpinal marrow. But there is a power of a peculiar kind belonging to mufcuiar fibres, by which they are enabled to move and contract themfelves for fome time, independent of the will, of their communication with the brain, and of life itfelf. For after the nerve which fplely fupplies a mufcle, has been tied, entirely cut through, or other- wife deftroyed, dill the mufcuiar fibres may be excited to contractions, by a fharp in- 2 ftrument, MEDICAL SKETCHES. 241 ftrument, or the touch of fome acrimonious fubftance. Even after the animal is dead, or when a mufcular part is cut from 'the body, this contrail fie power continues for fome time in the mufcular fibres ; it remains much longer in fome animals than in others ; and in all animals is more apparent, and remains longer in the heart, than in any other part. If the nerve going to a mufcle be irri- tated, the mufcle contrails, but not the nerve ; yet this irritability is not in propor- tion to fenfibility; for the heart, which is the moft irritable part of the body, is far from being the mod fenfible. Mufcles upon being irritated, generally contrail and relax alternately feveral times; the con- trailile force diminifiring each time till it ceafes entirely. The phenomena of irritability are undif- puted ; but phyfiologifts are not agreed re- fpeiling the caufe. ’ The moft prevalent R opinion 242 MEDICAL SKETCHES. opinion is, that this property is inherent in the mufcular fibres, totally independent of the nerves, becaufe it exifls after the com- munication with the brain is cut off. But this does not appear to me a fatisfaclory proof; becaufe although it urqueflionably does exift in the mufcular fibres, after their communication with the brain is deflroyed, yet it exifls but for a fnort time ; the nerve flill remains in the mufcle, and it is very poffible that the contractile power is en- tirely derived from the nervous influence received from the brain, before the com- munication was interrupted, and which continues to operate for feme time after. We know that every part of the body is kept alive by means of the circulation of the blood ; but if the circulation is Hopped for a few minutes in any particular member, that member will not immediately mortify. Animals will live a confiderable time with- out frefh fupplies of nourifhmentj but we would MEDICAL SKETCHES. 243 would not conclude from thence, that ani- mals are not kept alive by food. It ill accords with the beautiful fimplicity of Nature, to make ufe of two caufes, when one is fufficient to produce an effect. Since, therefore, it is evident, that mufcles are em- powered to move and contrad by the means of nerves and the communicatioa- with the brain, why impute this irritability to a new caufe, when it is equally accounted for by fuppofmg, that the nervous influence remains in the mufcular fibres for feme time after the communication is interrupted? The fum then of our knowledge of the nervous fyftem is, that the brain is the feat of thought, and origin of all fenfation and motion; that every fenfation is conveyed thither, every idea formed there, and the power of every motion proceeds from thence through the nerves to the mufcular parts of the body. R 2 We 244 MEDICAL SKETCHES. We know that the will can produce mo- tion in certain parts of the body, and not in others; that the nerves are the immediate inftrumenfs of feeling and motion; that all fenfibility and motion, except that particu- lar kind proceeding from irritation, depend upon the intercourfe between the moving part and the brain, by the nerves being en- tire ; that a general fympathy, by means of the nerves, prevails over the whole body; and that there is alfo a particular fympathy between particular parts. But by what means, or in what manner thofe things are brought about, we have not the fmalleft conception. Phyfiologifts have ftruggled hard to account for feme of them; but in my mind they have left the matter much as they found it. Seme have fuppofed that the brain con- veyed its influence along the nerves by vibration. The MEDICAL SKETCHES. 245 The Latin word ncrvus , which fignifies both the {mew of an animal, and the firing of a mufical inflrument, which excites found by vibration, probably led to this idea ; for in other refpeds, nothing can be lefs analogous to a tenfe -elaftic mufical chord, than loofe nervous filaments, generally im- merfed in a cellular membrane, unelaftic and incapable of tremulous motion. Befides, the nerves convey fenfation when they are relaxed, by bending the arm or leg, as well as when they are ftretched by extending the limbs. It has been maintained by others, that the brain is of the nature of a gland, and fecretes from the pureft part of the blood a refined fluid called animal fpirits ; and that the nerves are excretory duds, through which this fluid ifiues, at the command of the will, for all the purpofes of life ; that this fluid is gradually exhaufted by the labour of the body and mind, while we are R 3 awake, t 246 MEDICAL SKETCHES. awake, but during fleep a frefh fupply is fecreted for the occafions of our waking hours. It is unfortunate for this hypothefis, that this refined fluid happens to be fo very re- fined as to baffle the power of our fight, and of all the optical auxiliaries we can bring to its afliftance. Tire cavities of the nerves, which are fuppofed to contain this fluid, labour under the fame misfortune. If the dodtrine however were well fup- ported in other refpedts, thofe objections might be gotten over, for in many inftances we have a complete evidence of the exift- ence of things not feen ; to mention only one, we can, by the help of microfcopes, fee } and but jufi fee, certain animalcules; and we are fully convinced that thofe animal- cules are organized, and have veflels which we cannot fee. With MEDICAL SKETCHES. 247 With regard to the animal Ipirits being exhau.fted by the labour of the mind and body, and frefh fupplies accumulated during fleep, this may be thought liable to a ftronger objedion, in as much as we fee fo many people who fleep a great deal, and ufe neither bodily nor mental labour while awake, and yet feem not poflefled of more animal fpirits, or any other kind of fpirits, than their neighbours. It is certain however, that the nervous powers are exhaufted when awake, and re- ftored during fleep ; but it is equally cer- tain, that Nature requires only a competent fhare of fleep, as of food, to reftore her ex- haufted powers, and more than that of either has a debilitating, not a ftrengthening effed. Some phyflologifts, who feem in other particulars well enough fatisfied with this fyftem, hefitated when they reflected on the R 4 rapidity 248 MEDICAL SKETCHES. rapidity with which the will is obeyed by the moving mufcles, which feems incom- patible with the nature of any liquid ; and therefore they thought proper to convert the animal fpirits into a kind of elaftic va- pour, fecreted by the brain, which they imagined might move through the nerves with the facility and quicknefs of thought, and enable them to perform their duty in a more falisfadtory manner. Others dropping the idea of the brain’s being an organ of fecretion, or that the animal fpirits are drawn at all out of the blood, inform us, that there is a certain elajlic cether , of infinite fubtility, which per- vades all Nature : That this tether, when it meets with glafs, rofin, and fome other fub- itances, and is put in motion in a particular manner, produces all the phenomena of electricity; united with iron it is the caufe of magneti£n, and being modified in the brain and nerves by an organization which we MEDICAL SKETCHES. 249 we cannot conceive, becomes the agent of their powers. The eleCtrical fparks which hTue from the bodies of certain animals on friction ; the falutary effects of electricity in fundry difeafes, particularly in paralytic complaints, and fuch wherein the nerves are chiefly af- fected, are brought in fupport of this doc- trine, which is fuppofed to receive addition- al force from certain late obfervations re- lative to The fhock, lika the eleCtrical {hock, communicated by the touch of certain animals. Soft pulpy fubftances, as the brain, fpinal marrow, and melaftic cords like the nerves, feem however ill calculated for retaining or conveying fuch an aCtive fluid as that of eleCtricity; and if they had fuch a power, it would be ftill difficult to conceive that a comprefs or ligature upon a nerve could flop a fluid of fuch fubtiiity. But 250 MEDICAL SKETCHES. But if it were as eafy a talk to give a fatisfaCtory explanation of this abftrufe matter, as it is to ftart objections to every fyftem hitherto fuggefted, the means by which the brain acquires its powers, and the manner in which it conveys its influence to the remote parts of the body, would have been explained long ago. I have juft hinted the different opinions that have been entertained on this fubjeCt. They are detailed at a tedious length by various authors, and infilled upon with more zeal than they feem to merit. For even admitting the truth of any of the above hypothefes, they could be applied to no practical ufe; none of them are founded on experiment, and all of them fail in throwing any light on the fubjeCt which it is pretended they explain. The ridicule thrown by the fupporter of any one of thofe conjectures upon all the others, may with equal ftrength be retorted on his own; for i MEDICAL SKETCHES. 251 for it is as difficult to underftand how fe- creted fluids or elaftic sether can convey the fenfe of fmelling, &c. as that folid cords fhould do it. And whether the nerves are folid cords operated on by vibration, or hollow tubes containing a fecreted liquid, or fub- ftances which attradt a fubtile asther, of the nature of the eledtric fluid, ftill we fhould be in the dark how the will commands various movements of the body; how having the command of fome parts, it has not that of others, which are equally fupplied with nerves ; how certain parts are capable of fenfation only when they are in a morbid ftate ; how nerves, apparently of the fame ftrudture and nature, convey fuch different fenfations. The found of mufical inftru- ments affedts not in the fmalleft degree the optic nerves, while it delights the auditory; and the effluvia of a rofe, ,fo agreeable to the olfadtory nerves, gives no kind of fenfation to the two former. We 952 MEDICAL SKETCHES. We know in general, that certain pafflons of the mind produce particular effedts on the body ; but by what means they produce them, nobody has as yet been able to ex- plain. And that pafflons, the mod: oppofite and diflimilar, fhould in fome inftances pro- duce the fame effedt, feems equally unac- countable. Who could expert, for example, the fame rednefs of the face from the deli- cacy of modefty, that is produced by the violence of rage ? That the palpitation of the heart, and palenefs of the face, occafioned by fear, im- mediately proceeds from a contraction of the veflels, and from the blood being there- by flopped in its courfe, and thrown back on the heart, we naturally conjecture; but how that paflion does produce the con- traction, we cannot comprehend. And all the theories hitherto invented, leave us equally ignorant how to account for or remedy a difeafe, faid to be more frequent MEDICAL SKETCHES. 253 frequent in this ifland than elfewhere; and which certainly depends on fome affection of the origin of all the nerves, although from certain fymptoms, with which it is fometimes accompanied, it derives its name from another part of the body*. In this melancholy complaint, the patient, when apparently in good health, and per- haps in the moft opulent and defirable cir- cumftances, is gradually invaded by a lan- guor and dejediion of fpirits, which ren- der him averfe to every kind of exertion of body or mind, regardlefs of things of the greateft importance, and which for- merly interefted him the moft. — But he becomes infinitely attentive to a thoufand trifles which he ufed to difregard, and is particularly watchful of every bodily feeling, the moft tranfient of which he often * Hypochondriafis, a difeafe fo called from its feat be- ing fuppofed to be in a part of the belly which phyficians call the hypochondriac region. confiders 254 MEDICAL SKETCHES. confiders as the harbinger of difeafe ; and viewing objects through the medium which overclouds his own imagination, every thing appears to him dark and difmal. He is always apprehenfive of the word; ; and con- fiders the moll: indifferent and even the moil fortunate incident as the omen of fome im- pending evil. Although in his brighter days he may have been a man of courage, he becomes jprepofteroufly afraid of death, now when he feems to have loft all relifh for the enjoyments of life. Entirely occupied by his own uneafy thoughts and feelings, all other fubjects of converfation appear impertinent, and are in reality as intolerable to him as the ever- lafting theme of his own complaints gene- rally is to others : Meanwhile, as this dif- eafe is in reality more diftreffmg than dan- gerous, and as his looks are not impaired in a degree that correfponds with the ac- count he gives of his diftrefs, he feldom meets MEDICAL SKETCHES. 2 55 meets with that fympathy which his fenfi- bility requires and his bufferings defer ve. To a circufnftantial and pathetic hiftory of his complaints, he often receives a carelefs, and, to him, a cruel anfwer, importing that they are all imaginary. One who feels a weight of mifery more burthenfome than acute bodily pain, naturally confiders this as the greateft infult. Shocked at the un- kind indifference of friends, and the callous difpofition of mankind in general, he fhuns his former fociety, confines himfelf to his chamber, and will admit nobody but his phyficians, for if he can at all afford it, he confults one after another, the whole tribe. Being bribed to that patient hearing of his complaints, and that appearance of fympa- thy which the reft of his acquaintance refufe, they feem more tolerable company, and they poffibly relieve or palliate the coftive- nefs, the flatulency, the acidities, and other fymptoms which are brought on by the anxiety 256 MEDICAL SKETCHES, anxiety attendant on this complaint ; but the original caufe affe&ing the fenforium they leave as they found it. This caufe continuing in fpite of all their bitters, and their ftomachics, and their purgatives, and analeptics, the fame fymptoms conftantly recur. The wretched patient growing every hour more irritable and peevifh, he flies at length to quacks. Their well-attefled and infallible remedies hurry on the bad fymptoms with double rapidity ; he returns to phyficians, goes back to quacks, and occafionally tries the family noftrums of many an old lady. His conftitution being worn by fretfulnefs and by drugs, he at length defpairs of relief, and either finks into a fixed melancholy, or roufed by in- dignation, his good genius having whif- pered in his t&r^fugc medicos et medicamina , he abandons the feat of his difappointments, tries to diffipate his mifery by new objects and a different climate, confults no pra&i- 9 tioners 4 MEDICAL SKETCHES. 257 tioners of any country, fex, or denomina- tion; and forms a fixed refolution to fwal- low no more drugs, from which happy epoch, if the cafe be not quite defperate, he has the beft chance of dating his re- covery. * The difeafe now defcribed, though ac- companied with fome of the fame fymp- toms, is to be diftinguifhed from a direft affedtion of the ftomach and bowels, im- peding the procefs of digeftion, and occa- fioning want of appetite, heart-burn, aci- dities, flatulency, coftivenefs, and at length, if thecaufes of thefe complaints are not remov- ed, dejedtion and other nervous fymptoms. It is alfo different from what is called the hyfteric difeafe in women, which, befides the fymptoms above enumerated, is pecu- liarly accompanied with a pain in the left fide of the belly, with the fenfation of a ball rifing from the ftomach to the throat, S and 258 MEDICAL SKETCHES. and threatening fuffocation, with alternate fits of laughing and crying, with faintings and fpafms. What moft effentially didinguifhes the hypochondriacs from thofe tv. odlforders is, that the former gradually overfpreaas the ini ad in the frft infcancc, and often with- out any known caufc cf grief and vexa- tion : The other fymptoms are fecondary, occafional, and produced by the long con- tinued influence of the former ; wdiereas iodigeftion and the hyfteric difeafe do not neceffarily originate in any affection of the mind, the firft proceeding from a weak- nefs of the mufcular fibres of the ftomach, too great delicacy in its nerves, or foine fault in its digeftive fluid ; and the various and extraordinary fymptoms of the fecond originating in peculiar affections of the uterus, irregularities in the menftrual pe- riods, rod great fenfibility. In MEDICAL SKETCHES. 259 In a word, in the hypochondriacs the mental affection or deje&ion of fpirits is primary, and the other fymptoms fecondary. In the other two complaints, the alimentary canal or the uterus are difordered in the firft place, and the mental axfedionr are fecondary Another impor^art difdi&ic 1, between thefe two uiforders and the hypochondriafu is, that the farmer may be dirrunifheJ, and in many inftances entirely removed, by the judicious application of bracing, deobftrr • ent, carm'native, and fedetive medicines; * As women are fometimes thrown into hyfterical fits by being contradicted, by a fudden fright, or fome violent emotion of mind, thofe inftances may b» ♦’ o-ght incon- fiftenc with this opinion. I will Ay nothing of thr fits which feem to be owing to contradiction ; but as to the others, when we recolleCt that it is only during^ thofe years of life in which menftruation exifts, that women are fub- jeCl to hyfterical fits ; that they are moft liable to come . -hile the period is actually on them ; that obftruCticn., inde- pendent of any other caafe, occafion them ; tha t nnma-ried women are more fubjeCt to them that, ihoie wh~ a’-e married, and the barren than thofe who have cnildren ; we mult think that hyfterical complaints depend or fome affeftion of the uterus orovaria. S 2 whereas 2oO MEDICAL SKETCHES. whereas the chief affiftance we can give in the latter muft be derived from, other fources. I fhall here terminate the propofed view of certain parts of the animal oeconomy* Curfory and incomplete as this may be deemed, it is fufficient to fhew the folly and prefumption of thofe who pretend that it is in their power to remedy every diforder ’n a fyftem whofe effential functions are. ixap^r- fedtly underftood ; it fhew r s at the fame time that fo far from being furprifing that the art of medicine is unequal to the talk of curing every difeafe to which the human conftitution is expofed, it is rather won- derful that it can give fo much relief as in certain cafes it actually does. In no other art can the artift contribute to the rectifying a difordered machine of whofe ftru&ure he has an imperfedt know- ledge, and fome of whofe principal fprings he MEDICAL SKETCHES. 161 he is excluded, by unfurmountable obftacles, from examining. That the phyfician has this in his power, depends Indeed upon a circumftance in the animal conftitution which no production of human art can boaft — the conftant ten- dency, fo often mentioned, in difeafed nature to restore itfelf. If the productions of art polfelfed the fame advantage ; if, when the movements of a machine were by any accident impeded, h bad within itfelf the power of throwing cut the obflrudting caufe ; or when a fpring chanced to break, if it could folder and heal fpcntaneoufly, we might then fee men rife to eminence in the mechanical employ- ments without underftanding the common principles of their art. V/hen a watch went irregularly we fhould fee men totally ignorant of its mechanifm undertake to put it to rights with all the S 3 eafy 262 MEDICAL SKETCHES. eafy confidence imaginable. They would perhaps gravely open the cafe, look with becoming fagacity through a glais at the wheels, aftume an air of profound reflection, give it a random fhake, and then afliire the owner that all would be well in a fhort time. If after this, by its own energy it happened to recover its movements, the artift would of courfe have the credit ; but if unfortunately it did not, he would then fhake it again, according to a new method ; and if that failed, give it over as de- fperate. But as neither watches nor any other of the works of art are endowed with the fa- culty of reintegration, the artift, before he undertakes to mend them when out of order, is under the indifpenfable neceflity of underftanding their ftrufture and the laws by which they aCh And notwithftanding that fome fucceed without it, yet upon the whole, thofe who apply MEDICAL SKETCHES. 263 apply to the art of medicine had beft follow the fame plar, and fludy the animal ceconomy and the nature of difeafes with as much affiduity as if, like the watchmaker, they had nothing but their knowledge to depend upon. But whatever their acquired knowledge may be, they muft always re- member that Nature is the greateft of all phyficians, and that their chief bufintfs is to watch with all poffible attention which way her falutary efforts point, that they may, by every means which their know- ledge of the animal flrudture and ceco- nomy, and their own experience, or that of others, has taught them, affifl Nature in thofe efforts. s 4 /* r _ MEDICAL SKETCHES, PART THE SECOND, I. OF FEVERS IN GENERAL. I NOW proceed to offer a few remarks on certain difeafes. I begin with fevers, be- caufe the aiforders which have been arranged under that denomination are the moft com- mon and univerfal of any to which the human body is liable. When the circulation of the blood is quicker, and the body is hotter than is natural, there exifts a certain degree of fever. The moft part of difeafes are attended with an uncommon quicknefs of the pulfe, and 266 MEDICAL SKETCHES. and heat ; a greater or lefier degree of fever therefore is a fymptom of mod difeafes. What is commonly underftood by the term fever , however, is a complaint be- ginning with a fhivering, or, at lead a fen- farion of cold, foon followed by a quick pulfe, univerfal heat, and diforder of the natural functions, but not originating from a wound, or the diredt affedtion of any par- ticular part of the body. When an affedtion of any part in parti- cular, whether from an internal caufe or an external injury, is the primary and edential complaint, the fever which accom- panies this is confidered as a fymptom only, and the difeafe is not denominated a fever ; but when the caufe of fuch a local affedtion is internal, the difeafe derives its name from the organ affedted ; and if it proceeds from an external injury, it is ffmph called a wound or bruife. Thus an inflammation of the membrane that lines the interior furface of the thorax (the MEDICAL SKETCHES* 267 (the pleura), is called a pleurify, an inflam- mation of the kidneys a nephritis, of the liver hepatis, and fo on. As fevers arife from different caufes, affeft people of different confutations, vary in different climates and feafons, they muff of courfe be different in their nature, and require a different treatment. Notwithstanding thofe differences, there are certain fymptoms and circumftances common to all, which unite them under the general name of fevers. The effential fymptoms common to all fevers at their firft attack are, languor, wea- rinefs, and forenefs of the flefh and bones, followed by a fenfe of cold, which begin- ning in the back gradually creeps over the whole body. This coldnefs, in fome, is attended wich gentle irregular fhudderings, in others with a ftrong fit of fhivering, with palenefs of the fkin and lips, drynefs of the mouth, a want of appetite, an inability to fleep, impaired fenfibility, and often fome degree 263 MEDICAL SKETCHES. degree of confufion of thought. The cold- nefs is fucceeded by an uncommon heat over the whole body, and the drynefs in the mouth, by great thirft. At laft a fweat, more or lefs profufe, breaks forth, and the body becomes, in fome degree cooler, or perhaps returns intirely to its natural ftate. I N . * y - Divifion of Fevers. If the difeafe concludes within the fpace of twenty-four hours, it is called by phyfi- cians an ephemera, or a fever of one day. If the fame fymptoms regularly return and go off at the hated intervals of one or two days, the difeafe is an ague, or inter- mittent fever. If, with little or no evident abatement, the difeafe proceeds with equal, or increc fing violence, it is then called a continued fever. The term is not ftriftly accurate ; for there is reafon to believe that ail fevers, except ephemerae, are attended with diur- nal X MEDICAL SKETCHES. 269 nal exacerbations and remiflions. As thofe* however, are very different from the in- tervals above mentioned, often efcape the notice of the carelefs, and fometimes are diftinguifhed with difficulty by the moft; attentive obfervers ; fevers are with pro- priety divided into two claffes, the con- tinued and the intermittent. The latter are. readily diftinguifhed from, the former by the total abfence of fever during their intervals ; . and they are diftin- guifhed from each other by the names quo- tidian, tertian, and quartan, according to the duration of thofe intervals. Divifion of continued Fevers . Continued fevers have been divided and fubdivided by various authors with fuch a parade of learning, and fuch an affectation of precifion, as terrifies the diffident ftu- dent and perplexes tne moft experienced practitioner. Who. 270 MEDICAL SKETCHES. Who would not be alarmed on being in- formed that fuch a formidable band, fuch a febrium cohors as the following, had in- vaded the earth — febris inflammatoria, fcor- butica, foporofa, putrida, nervofa, typhus petechialis, flava, fudatoria, colliquitiva, ardens, hedtica, cephalalgica, bilofa, ery- fipelacea, fynocha, fynochus, paludofa, ver- minofa, maligna, &c. &c. &c. And after being thus informed, who could be fur- prifed to find that death walked with a haftened ftep through the land * ? To lay hold of the occafional fymptoms which arife from the differences of conftitution and other circumftances, and eredt them into new difeafes with terrifying names, burdens the memory, and tends to darken rather than elucidate. * Nova Febrium Terris incubuit cohors : Semotique prius tarda neceffitas Lethij corripuit gradum. Hor. lib. i. carm. 3. He MEDICAL SKETCHES. 271 He who breaks a loadftone into a great number of pieces will throw as little light upon the nature of magnetifm, and dis- cover as little of its caufe, as if he had left the loadftone entire. To give terms inftead of ideas, is a prac- tice not confined to phyficians : From long eftablifhed cuftom, however, fuch counters feem to pafs more currently, and are oftener received in exchange for gold, from them than from others. Thofe who are folicitous to be thought profound, do not always wilh to be intelli- gible ; they gain their purpofe more effec- tually without it. My chief aim, on the prefent occafion, is to be ufeful. I muft therefore endeavour in the firft place to be fully underftood. I do not pretend, by any new fyftem, to explain what writers of far greater genius have left in obfcurity ; but perhaps giving fome of their ideas in a plainer and fimpler 7 drefs, tji MEDICAL SKETCHES* drefs, and adding fuch of my own as expe- rience and reflection have confirmed, will be of fervice. m Two very different ftates of the human body are fuppofed to accompany the dif- eafes comprehended under the name of fevers, and to form their great and funda- mental diftinCtion. One is called the phlogiftic diathefis, or inflammatory difpofition; by which the heart is excited to rapid and ftrenuous exer- tions, during the continuation of which there appears great ftrength in the aCtion of the veflels, and the blood itfelf feems to be of a firmer and denfer texture than ufual. In the other, the brain and nervous fyftem. are more dire&ly affeded, their energy feems impaired, the force of the heart and veffels is diminifhed, the blood is of a loofer texture, and in a more difi'olved date, and the animal juices tend, as fome have imagined, to putrefaction. la MEDICAL SKETCHES. 273 In the firft ftate, when the inflammation originates from external caufes, as wounds* contufions, or burns, the fever follows the local affedion, and is in proportion to the degree of inflammation, and to the import- ance of the part or organ afreded. This is alfo the cafe in certain diforders of the lungs, liver, and other vifcera, which arife not from external injuries, but from fome vice in the part which gradually brings on inflammation, and the inflammation fever. If the local inflammation is removed, the fever is removed alfo ; if it cannot be re- moved, but increafes, gradually deftroying the organization of the part, the patient dies fometimes by the violence of the fever, and fometimes merely becaufe an organ necef- fary to life is deftroyed. In all thefe cafes therefore, the difeafe is not a fever, but a local inflammation pro- ducing feverilh fymptoms* T Thefe MEDICAL SKETCHES. 274 Tliefe fymptoms are fhiverings, a ftrong, hard, and full pulfe, heat, thirft, refdeffnefs j. and if any blood is drawn, a thick gluey fubftance of a buff colour will be foort formed on its furface. But it often happens that people are feiz- ed with fhivering, and all thefe fymptoms in a ftrong degree, without any external violence, or the affedlion of any particular organ, in this cafe the fymptoms being the fame with what occur in local and vihble inflam- mations, the -whole mafs of blood is fup- pofea to be affedted in the fame manner as when they evidently exift* and this difeafe is naturally enough called an inflammatory- fever. The other fpecies of fever, when pure, difplays fymptoms very different, and in fome refpefls oppofite to this inflammatory irritation. 3 "Weak MEDICAL SKETCHES. 275 Weak and quick pulfe, debility, and pro- ftration of ftrength, heavinefs and dejedion of fpirits, as if the vital principle were in- vaded by fome baleful influence adding diredly on the nervous fyftem; — thofe and other fymptoms have procured this fever the name of nervous. When the fame fymptoms attack with a greater degree of violence, it has been called malignant ; and as dufky brown, violet, or black fpots, and vibices or blue marks like bruifes, imputed to a putrid fate of the fever, fometimes appear, it is alfo called the putrid fever. Thofe and various other circumftances .however, feem to form no eflential dif- tindion. The whole may be comprehend- ed under one name ; and provided the fymptoms which difcriminate this from the inflammatory fever be accurately defcribed, It is of no importance which is chofen. T 2 If a 7 5 MEDICAL SKETCHES. If fevers always were found in Nature as pure, unmixed, and diftinct, as they are defcribed in authors, the labour of thofe who apply their minds to the ftudy of me- dicine might be greatly abridged. Afk a very young ftudent of phyfic what Is to be done in an inflammatory fever, and he will anfwer, without hefitation, that you mull bleed and dilute. Aik again what is to be done in a ner- vous, malignant, or putrid fever, and he -will anfwer with equal readinefs, you muft give the bark, &c. Carry him to the bed-fide of a patient with a pretty ftrong and hard pulfe, con- fiderable heat and drynefs of the fkin; here, he will ftiy,is a vigorous motion at the centre of the vafcular fyftem, with great contrac- tion, and ftrong reftftance by the veflels at the circumference ; to allay the internal commotion, and relax the fpalm, plentiful venefeduoi: muft be ufed, and great quan- tities MEDICAL SKETCHES. 2/7 titles of cooling bland diluting liquors ijiuft be drank ; but on farther examination, he finds uneafinefs in the head, naufea, dejec- tion, and impaired fenfation and debility, fyinptoms indicating a direCt nervous af- fection, and for which, had he found them unaccompanied by the former, he would have prefcribed corroborants, cordials, and antifeptics ; but finding them thus com- bined together, he does not know whether to call the difeafe inflammatory or nervous, and of ccurfe is at a lofs what to prefcribe. In reality, it requires much experience, fagacity, and attention, to decide what courfe ought to be followed in thofe com- plicated cafes, where the two genera are fo intimately blended, as often happens in the continued fevers of this iflanu. The Caufes of Fevers. It is ufual for writers to enumerate what they confider as the caufes of fevers , thefe T 3 they 2 7 3 MEDICAL SKETCHES. they divide into two claiTes, the remote -and the proximate. Under the firfc head fome have favoured the public with a lift of almoft every thing that can diforder the human body. Full diet, thin watery diet, hot diet, too. great exercife, too little exercife, drinking cold watery liquors when the body is hot, warm liquors when the body is cold, and fpirituous liquors whether the body is hot or cold; plethora, hemorrhages, flopping of iflues and other evacuations, the retention of excrementitious or other offenfive matter in the ftoinach and bowels, cold dry winds, inoift weather, hot weather, change of cli- mate, night- watching, intenfe thought, ve- nery, fear, grief, anxiety, the miafmata, or certain particles floating in the air, and which arife from marfhy grounds acted upon by heat, and the effluvia which con- ffantly flows from living: human bodies pent up or confined from being diffufed in the atmofphere. What MEDICAL SKETCHES. 279 What produces many miftakes and dif- ference of opinion refpedting the caufes of difeafes, is, that we know little or nothing of the relation between caufe and effedt, but merely that we fee the one follows the other. When a philofopher holds any thing in his hand, a leaden bullet for example, he knows it will fall to the ground on his i'preading his fingers; the moft ignorant peafant knows the fame, and for the fame reafon, becaufe he has feen it always hap- pen fo. The difference between the philofopher and peafant is, that the former will endea- vour to find out w T hy it always happens fo ; whereas the latter will be fully convinced he knows it already, and that he could hav£ foretold that lead and every heavy fub- fiance, mull neceffarily fall to the ground, although he never had feen or heard of fuch a thing in his life : Nothing can be clearer, he would fay. than that a bullet T 4 viujl i8o MEDICAL SKETCHES. mujt fall to the ground, when It is not fup- ported. Yet it is evident that it might have been as natural, for aught he or the greateft phi- lofopher alive knew before trial, for the bullet or any other fubftance to have mounted upwards, have taken an horizon- tal direction, or remained felf-fufpended in the air. And although the philofopher fhould never be able to difcover any other relation between two events, bat that the one al- ways follows the other, he will agree with the peafant in calling the firft the caufe of the fecond, and all the world will follow their example. If we fee the events happen in this fuc- ceifion in a great number of inftances, al- though the fecond fhould happen without being preceded by the firft in a few, ftill we will fufpedt the firft for its caufe, notwith- standing that fomething or other, we do not know what, prevents its appearance in fome cafes ; MEDICAL SKETCHES. 281 cafes; this however raifes doubts; w T e are not quite fo certain as we were. But fevers are not always and regu- larly preceded by the fame events, but fometimes by one, fometimes by another, and fometimes by a number together; in fuch cafes therefore, we need not be fur- prifed that there are frequent miftakes and a variety of opinions refpedting their caufes. Indeed, if the catalogue of caufes above enumerated is admitted, we never can be at a lofs for a caufe for a fever or any other difeafe, for few events of our lives are not preceded by fome of that lift. But it is evident that the greateft num- ber of them have at moft only a tendency to predifpofe the body in fuch a manner, that fome lucceeding caufe, which of itfelf might not have been fufficient to induce a fever, may have that effedt ; or if the fuc- ceeding caufe would have been fufficient to produce a fever, the predifpofing caufes above 2 g2 MEDICAL SKETCHES. above enumerated may render the difeafe more obftinate and dangerous. I Avail examine only a few of thofe re~ mote caufes, under which the greater part of the others may be naturally enough in-* eluded. I begin with cold. Sydenham fays, Caufa evidens externa febrium quampiurimarum inde petendaeft, quod quis fcilicet vel pracmaturius veftes ab- jecerit, vel exercido inealefeens fe frigori incautius expofuerit ; and a little after he adds, Et fane exiftimo plures modo jam de- iignato, quam Pefte, Gladio, atque Fame, fimul omnibus perire. This laft feems a very ftrong exprefhon, but is probably applied to all who die in confequence of obftrudted perfpiration. — Whether the diforder it produces be what is properly called a fever, or a peripneumony, an hepatitis, or any other difeafe ; in this fenle and in this illand, unquestionably more people MEDICAL SKETCHES. 283 people are deftroyed by the caufes mention- ed by Sydenham than by the plague, fword, and famine. Exppfmg the body for any length of time to a greater degree of cold than it has been accuftomed to, is evidently the fource of a very great number of difeafes. The immediate effect of this is a contrac- tion of the pores on the furface of the body, by which means the fluid particles which lifually pafs this way are retained, and thrown back into the general mafs, which when long continued is found greatly to fiifturb the animal functions. Knowing that ftoppage of perfpiration fometimes produces dangerous difeafes, it is natural to be furprifed that difeafes are not ilill more frequent ; that they do not hap- pen in confequence of every change from a warm climate to a cold, or of every change from warm to cold weather, or of remain- ing for any time in a colder room than we are 2.84 MEDICAL SKETCHES. are accuftomed to ; or, in fhort, of all thofe ftoppages or diminutions of perfpiration which muft happen to the moft wary. This would inevitably be the cafe if Nature did not contrive to prevent it, by invefting the different organs of fecretion with the power of mutually affifting each other ; a defi- ciency in one being generally compenfated by the augmentation of fome other, ✓ The agreeable vicifhtude by which an i - termediate feafon is always placed, between the heat of fummer and the cold of winter, is another means by which Nature guards againft the difeafes to which the human body -would be liable, if it were not thus gradually prepared for the lucceeding ex= treme by a moderate intervening feafon, But the admirable arrangement b} which each feafon is blended with that which precedes it, and then by degrees affumes the nature of that which is to follov although it certainly prevents in a gre; meafurc MEDICAL SKETCHES. 2S5 meafure the deftru&ive effects which a hid- den change from fummer to winter, and from winter to fummer, would have on the human conflitution, does not entirely hinder the fucceffive feafons from producing changes in our bodies which difpofe them to par- ticular difeafes, as is evident from the na- ture of the epidemics peculiar to the different feafons, which are more regular in many other countries than in the variable and uncertain climate of Great Britain. Cold is found, by univerfal experience, to give a difpofition to inflammatory dis- orders, and heat to thofe of that nature which has been called putrid. During the winter, and early in the fpririg, pleurifi.es, penpneumonieS; inflammatory anginas, rheumatifms, and inflammatory fevers, pre - vail. Towards the end of fummer, and particularly in autumn, fevers of a different nature, dyfenteries, and putrid ulcerous fore throats, make their appearance. If 235 MEDICAL SKETCHED If the former are more frequent in tire fpring than during the winter, this is im- puted to the cold being more heady in winter ; whereas in fpring many people are tempted, by the heat of mid-day, to throw off part of their clothes, and contract difeafea from the unexpected- chilnefs of the fame evening. That autumn is more unwholefome than fummer is thought to be owing to this, that the human body, after being relaxed by the long heats and enervated by tire profufe perfpiration of the fummer, is then more affedted by the cold of autumn ; and like- wife becaufe the air then abounds with the exhalations of putrid animal and vegetable fubftances, which are thought to have a morbid effedt on the human body. Of late it has been doubted by fome phyficians of great eminence, whether cold alone, without the concurrence of other caufes, particularly marfh or human effluvia, can produce a proper fever. But MEDICAL SKETCHES. 2S7 But when a perfon, upon throwing oh’ part of his clothes, or on remaining in a cold or moift place for an unufual length of time, is immediately feized with a fever, in my opinion it is highly reafonable to think the cold, to which he has been im- accuftomed, is the caufe, and not thofe effluvia or miafmata, call them what you pleafe, which, for aught we know, he has been ihfpiring and abforbing, in as great quantities at other times, as when he fell into the fever. It may be faid indeed that there is no proof that thofe miafmata have not had a great effedt at this particular time, although they had none before. But if a perfon fell down fenfelefs, in coniequence of a violent blow on the head with a bludgeon, it might alfo be faid that the blow would not have had fuch an effect without the concurrence of an apoplexy which the perfon was feized ■with, at the inftant he received the blow : And whoever afferted this might reft fecure * that a8S MEDICAL SKETCHES. that there could be no abfolute proof to the contrary. All that can be faid is, that when we fee people feized with inflammatory fevers after th$ir bodies have been expofed to the im- preflion of a fharper cold than ufual, and for an unufual time, we have the fame reafon to believe that cold is the caufe of the fever, that we have for believing that any caufe produces any eflfedt. Although it is true in general, that cold occafions a difpofition to difeafes of an in- flammatory, and heat to thofe fuppofed to be of a putrefcent nature, yet thofe who are ccnftrained by neceflity or by duty to take violent exercife in fultry weather, and thofe who accidentally fall afleep on the ground expofed to the beams of a mid-day fun, are fometimes feized with fevers of a highly in- flammatory and dangerous nature ; the in-* flammation diredtly affedting the brain itfelf or its membranes. i» medical sketches; 289 It would feem that v eat gradually and uniformly applied has a conflant tendency to relax and debilitate the human conftitu- tion ; for we find in general that the inha- bitants of hot climates are more effeminate and lefs capable of great exertions than thofe Of the moderate and of the colder ; and we alfo find that the common difeafes of the warm climates are of a nature the reverfe or inflammatory. Yet fudden and exceflive heat from fevere exercife in a hot day occafions the moft violent inflammatory fevers, as too much heat partially applied occafions the moft violent local inflamma- tions. But where no fuch exceffes have been fuddenly ufed, only the heat of hum- mer allowed to ad gradually on the body, there can be no doubt that, it tends to re- move from the conftitution the inflammatory difpofition produced by the cold of the^pre- ceding feafons, and difpofes to difeafes of a contrary nature, attended very often with U diforder igo MEDICAL SKETCHES. diforder in the llomf? h and bowels, and the' appearance of a redundancy or acrimonious ftate of the bile. Towards th’e end of Auguft, particularly after fultry weather followed by rain, the difeafe called cholera, or a vomiting and purging of bilious matter, attended with fevere gripings in the inteftines, often pre- 1 ails in this ifland. There is every reafon to believe that this difeafe flows from the heat of the weather producing an increafed fecretion of bile, and at the fame time rendering this liquor fo acrimonious as to produce painful irrita- tion of the ftomach and bowels. That this is the caufe is the more probable, as the beft inethod of removing the complaint is by throwing great quantities of mild diluting liquors into the body, which at once favour the evacuation of the redundant bile, blunt its acrimony, and flieath it from irritating the alimentary 'canal* About MEDICAL SKETCHES. i 9 i About the fame period, and proceeding from the fame caufes, the exeefiive heats of fummer, followed by the moifture of Autumn, dyfenteries aiid the fever called bilious appear— -a name firft given to it ori account of the bilious vomitings and purg-' ings, the yellow colour of the fkin, and other fymptoms of a redundancy of bile which attend it. C A difpofition in the bile to pafs off in great quantities by its fecretories, is obferv-*- able in all warm climates as well as in warm feafons. Thofe who go from a cold to a hot climate, therefore, are generally foon after attacked with bilious fevers* There are ftrong reafons to believe* however, that this unufual quantity of bile is to be reckoned among the effects and not among the caufes of this fever, which in Great Britain is often of the mixed kind, generally beginning with inflammatory fymptoms and ending with thofe of debility and, fuppofed put ref' U 2 cencv. 292 MEDICAL SKETCHES. cency ; the increafed fecretion and acri- mony of the 'bile aggravating the other fymptoms of the fever. In what degree it leans to the one or the other, in feme meafure feems to depend on the ftate of the weather during the courfe of the difeafe, and the' particular conftitu- tion of the patient ; the robuft and fanguine fhewing a ftronger tendency to the former, and the weakly to the latter. Intoxication is reckoned among the caufes of fever. The general bad effects of this upon the human conftitution are too obvious to be infilled on. Wherever a predifpofition to any parti- cular difeafe lurks in the conftitution, in- temperance in drinking feldoin fails to route it into action. Repeated excelfes of this kind fometimes produce the epilepfy in thole never before fubjeft to it, and always haftens the returns, 9 and MEDICAL SKETCHES. 293 and augments the violence of the fits in thofe who are. 1 have known a fingle inftance of intem- perance bring this dreadful diforder back with violence upon thofe who by former moderation had warded it off for years. To increafe good humour, gaiety, and wjt, and prolong the pleafure of converfa- tion, is the ufual apology for fuch exceffes. But if it were a general rule to leave the company at foon as our tafte and talents for fenfible or witty converfation began to di- minifh, few would injure their conftitutions by drinking. There are indeed examples of people who fupport long and repeated exceffes without much apparent injury. There are alfo inftances of people who have fwallowed poifon with impunity. But let thofe who are acquainted with fuch tough and well-feafoned veterans recal to memory the numbers of their companions, who, yielding to importunity, have fallen U 3 victims 2g 4 MEDICAL SKETCHES. victims to this eafmefs of temper, and they will not be much encouraged by the ex- ample. The daily practice of drinking to intoxi- cation mutt be confidered as improper, if there were no other argument againft it than its depriving us of the advantage of an ad- mirable and efficacious remedy in many diforders, as is well obferved by the cele- brated commentator on Boerhaave’s apho- v rifms : 44 Ilia autern acrimonia, quse fer-. 44 mentatis liquidis ineft, miro ftimulo atque * c efficaciffimo audlam cordis velocitatem 44 efficere poteit ; unde in morbis languidis 44 et frigidis vini et cerevifiae generofioris 44 moderatus ufus adeoprodeft. Immodtco 44 horum ufu febres, crapulares dictas, 44 excitari, nimis notum eft ; verum levia 44 haze funt, folentque ab illis, quibus fo~ 44 lenne eft hefterna vena’s habere inflatas 44 Iaccho, contemni *. 55 $ Gerardi Van Swieten Comment. tojn. Fecund. p. 31. For MEDICAL SKETCHES. 295 For although intoxication never fail* when firft indulged to produce moft of the fymptoms which attend fever, as heat, drowth, headach, and naufea, it muft be confefled that thefe wear away by habit ; £0 that thofe who indulge every day in the bottle, if they furvive the exceffes of their youth, and efcape eonfumptions, dropfies, and paralytic complaints in more advanced life, are in little danger of being cut off fuddenly by a fever from drinking ; they will have the comfort of outliving not only their friends but very probably their own nnderftandings. Thofe who are not habituated to intern** perance are often throw n into violent fevers by that degree of excefs which is barely fufficient to put a perfon of the above de* fcription into tolerable good humour, and difpofe him to a comfortable night’s reft. In fome inftances where people have fallen down infenlible by extraordinary U 4 $x$e& 296 MEDICAL SKETCHES. excefs in drinking, a fupervening fever has been considered as the only thing that faved them from a fatal apoplexy ; as is remarked alfo by Van Swieten, who having quoted the following maxirn from Hippocrates, Si quis ebrius de repente obmutefcat, con- “ vulfus moritur, nifi eum febris corripue- “ rit, aut qua hora crapula folvitur, vocem “ edat,” adds farther, “ fed in Commen- “ tariis 558, ex Hippocrate notatum fuit “ fummam ebrietatem fequi obmutefcen- “ tiam, et lethalem quandoque apoplexiam, “ nifi febris orta remedia fuerit and then quotes from the third book of Hippocrates's Epidemics the instances of two perfons who “ ex potibus ambo periculofa febre decu- u buerunt ; quorum primus fecundo jam “ morbi die furdus fadtus fuit, dein ferociter “ deliravit, quarto die convulfus, quinto “ die periit. Alter vero poll difficilera 6 ‘ morbum, vigefimo die evafit.” What MEDICAL SKETCHES. 007 What appears certain from thefe quota- tions, is the great danger of exceffive intoxi- cation; that in fome cafes it inftantly kills, in others produces a violent fever, of which fome die, and others with difficulty recover ; and that, in the opinion of Hippocrates and Van Swieten, the fever was the means Nature ufed to bring about the recovery. Some people will have the prefumption to difpute the laft article ; but admitting it, {fill it mult be allowed that a difeafe mull be of a very defperate nature for which a fever is the only remedy, and this remedy pot always effectual ; for it fometimes hap- pens, particularly to young perfons of a fanguine habit, that, in confequence of great excefs in drinking, a fever of fuch violence is raifed that the patient dies after a few days of high delirium. Violent paffions of the mind, particularly thofe of rage, fear , and grief are reckoned among the remote caufes of fever. There 3^3 MEDICAL SKETCHES. There are doubtlefs inftances of rage, when kindled to an exceffive height, pro- ducing an apoplexy : The fame paffion in a fmaller degree, or in a different conftitu- tion, it is faid, may produce a fever: I cer- tainly fhall not deny that it may, but I never knew an inftance of it. A fudden fright is a very frequent caufe of epilepfy, particularly in young people &nd children. Fear inftantly checks perfpiration, difturbs all the fecretions, and the natural courfe of the animal ceconomy. Grief has the fame effeds in a fmaller degree j but the paffion is generally of longer duration ; both impair the appetite, retard digeftion, diminiffi the energy of the brain, and the addon of the heart ; and dif- pofe the body fo very much to the dileafe, that in this fituation we frequently fee a nervous fever arife, for which we can per- ceive no other caufe. Long MEDICAL SKETCHES. 299 Long continued coftivenefs, and the re- tention of excrementitious or other offen- five matter in the ftomach and bowels, is alfo clafled among the caufes of fever. It is evidently the caufe of lofs of appe- tite, naufea, flatulencies, feverilh heats, and much general oppreflion; but I have never feen a formed fever, in adults, that I could impute to this caufe alone. When a fever takes place indeed, from whatever caufe, coftivenefs generally fol- lows, and unqueftionably has a tendency to augment all the fymptoms. I faid I had never feen what could with propriety be called a fever, "which originated in this caufe alone in adults. I confined my exprefljon to thofe of that clafs, becaufe I do think this caufe, independent of any other that we can perceive, does produce fever in children, not only by ftimulating the nerves of the inteftines in the fame manner that worms do, but alfo by part of the acrimonious matter being abforbed and thrown 3 oo MEDICAL SKETCHES. thrown into the mafs of blood by the ladteals. It will be faid, that grown people are ex- pofed to thofe caufes as well as children: They are fi>; but they feem not to have the fame effect on the firmer and lefs irritable conftitutions of the one, that they have on the other. If this reafon is not thought fufficient, another may be adopted. The fadt re- mains unmoved. In fuch cafes no doubt, the firft thing that is to be done, is to cleanfe the whole ali- mentary canal by proper purgations ; but although this prevents more fuel from being added, it cannot at once extinguish the flame already kindled ; the fever continues for fome time, and requires a particular treatment. For the removal of a caufe does not al- ways remove the effedts, which fometimes become the caufes of new and obftinate fymptoms. Excefs MEDICAL SKETCHES. 30s Excefs in venery is alfo reckoned among the remote caufes of fever. The general effects of fuch imprudence are languor, weaknefs, and dejection ; and that this predifpofes or renders people more liable to be infe&ed by the other dire£t caufes of the nervous fever than they would otherwife have been, is molt certain ; and fome people think excefles of this nature of themfelves may produce a nervous fever without any other caufe. The fentiments exprefled by Celfus on. this fubjecft feem highly rational : “ Con- “ cubitus vero neque nimis concupifcendus, “ neque nimis pertimifendus eft. Rarus cor- 4t pus excitat, frequens folvit. Cum autem. “ frequens, non numero fit, fed natura, ratione astatis et corporis; fcire licet, cum non inutilem efle, qu'em corporis “ neque languor, neque dolor, fequitur.” — > Celsus, lib. i. cap. 1. But 302 MEDICAL SKETCHES. But fevers are often epidemic, and num- bers of perfons affedted, on whom none of the caufcs above enumerated can be fup- pofed to have operated, or cannot be fup- pofed to have more force at the period ivhen the epidemic prevails than at any Other time. They mufi therefore, in many inflances, proceed from fome other caufe. Certain noxious particles floating in the atmofphere, and more prevalent, or more powerful, at particular feafons, and in par- ticular places, than in others, are according- ly confidered as by far the moft general caufes of fevers. Thofe miafmata are fup- pofed to be the effluvia of ftagnating cor- rupted water, and putrefied vegetable an$ animal fubftances. C "T T : f ' ■ , ( : J They are too minute to undergo the ex- amination of our fenfes, yet we can have little doubt of their exiftence, and ftill lef3 of their being the chief caufe of intermit- tent fevers j and combined with cold, the • 2 ' frequent MEDICAL SKETCHES. 303 frequent caufe of the continued fever to which fo many different names have beeri given ; as bilious, remittent, &c» The following confiderations make this amount to a certainty. Intermitting and remitting fevers abound In every climate, in the neighbourhood of moifl marfhy foils ; in woody countries, where the air is confined by the number of trees; in low flat countries, where there is a great quantity of ftagnating water, and no hills to direct a brifk ventilation. The inhabitants of the mountains and of the valleys, where there are running waters, a dry foil, and ftrong Ventilation, are not fubj e£t at all to agues, and very feldom to the bilious fever, while they remain in their own country ; but in general are liable to be feized with one or other, when they come to the fenny countries. Even in thofe countries the richer ranks of inhabitants who have dry apartments above 394. MEDICAL SKETC HES. above ground, are lefs liable than the poorer fort, who are obliged to continue longer in the fields, expofed to the baneful influence of the marfh miafmata, and fleep on ground floors. Of the poorefi fort, the inhabitants of the towns and larger villages, where the noxious quality of the atmofphere is corrected by numerous fires, and ventilation is produced by the arrangement of the houfes into ftreets, are lefs fubjedt to the diforders in queftion than thofe who live in detached cottages. The bilious remitting fever very feldom originates on board a fhip ; but it is often carried on board by feamen or foldiers who have caught it when on the watering duty, cutting fuel, or on any other fervice which required their being on fhore. There are inftances of feamen’s having been put on Ihore on account of the fcurvyj and al- though MEDICAL SKETCHES. 305 though the frefh vegetables they then ob- tained foon cured them of that difeafe, yet if the country on which they landed was marfhy, and in the neighbourhood of'tvoods, it has been obferved, that they foon after- wards were feized with bilious remitting fevers *. The feafon in which fevers are moft pre- valent, is the end of hammer and beginning of autumn, when heat and moifture com- bine to haften the corruption of animal and « vegetable fubftances, and fill the atmofphere with an unufual quantity of miafmata. Thofe c.onfiderations render it next to a certainty, that fomething effentially con- nested with a marfhy foil produces fever; and we can fuppofe nothing with fo much probability as the effluvia of ftagnating * Vide Medical Obfervations and Inquiries, by a Society of Phyiicians, vol. iv. article 12. We are there informed, that in one (hip the officers who never had the (curvy on deeping alhore one night, were feized with this bilious fever ; fo were the carpenters and boat’s-crew, who were neceffarily alhore ; All who re- mained aboard continued free from it. X water. 306 medical sketches. water, and corrupting vegetable and animal fubftances. And if a fudden ftoppage of perfpiration, from the cold of autumn, after the body is relaxed by the preceding heat of fummer, is fufficient of itfelf to produce fever in dry and well ventilated countries, where there is no reafon to think that marfh miafmata prevail, we cannot be furprifed to find them far more univerfal, and more obftinate in low and marfhy foils, w T here the firfl caufe ' concurs with the fecond. But there is another caufe more aflive than either, or than all the others taken to- gether, in producing fevefs of peculiar dan- ger and malignity; — the effluvia conftantly flowing from the living human body, which when long confined in the fame place, and prevented from expanding in the atmo- fphere, becomes in the higheft degree acri- monious, and the caufe of fevers equally contagious and malignant. AVherever MEDICAL SKETCHES. 307 Wherever numbers of people are crowded together in clofe places, the air of which muft foon be deprived of part of its vital power, by repeated refpiration, this infec- tious matter will be formed ; but with moft rapidity in jails, in the holds of fhips, and in hofpitals, where its virulent tendency is haftened by naftinefs, by unwholefome food, by defponding thoughts, or by the effluvia coming from bodies in a difeafed ftate. It communicates its contagion not only to thofe who approach the places in which it is generated, and the human bodies from which it flows; but alfo will remain long entangled in blankets, beds, and other fub- ftances which have been in contadl with the patient’s body; retaining its activity, and capable of infe&ing others at a confiderable diftance of time, or at a confiderable diftance of place, if unhappily thofe contaminated materials are carried to a diftance. X 2 In 3© 3 MEDICAL SKETCHES. In this manner one perfon who is not himfelf infeded may infeCt another, the firft being lefs predifpofed to the difeafe than the fecond, and carrying the infedion in his clothes from one in the fever, to another perfon in good health. Although the contagious miafmata arif- ing from the living human body, are not perceived to ad at a great diftance from their dired fource, or the fubftances with which they are imbued ; yet it feems moft probable that they do not imme- diately lofe their virulency, but, after they are diffufed in the atmofphere, con- tinue in fome degree to ad in conjunction with the miafmata of marfhes, with heat, obftruded perfpiration, and the other caufes, in producing fevers ; and according to the various proportions of thofe caufes, com- bined with the circumftances of feafon, climate, and the conftitution of the patient, the nature of the fever is determined. Having MEDICAL SKETCHES. 3 o 9 Having pointed out what are confidered as the moft common caufes of fevers in general, I fhall fhortly hint what appears to be the molt probable fource of each parti- cular fpecies of fever, according to the divifion adopted above. Other circumftances may aflift, or poflibly on fome occafions produce them; but in general it appears that the effluvia of marfhes is the caufe of intermittent fevers. Cold, of the inflammatory fever. The human miafmata, of the nervous fever. And that the mixed fever is the product of all the three fources, which as they hap- pen to be proportioned, incline it fometimes to the nature of the inflammatory, fome- times to that of the nervous fever; and from the marfh effluvia it derives its remit- ing tendency, with other features refembling the intermitting fever. It would not be a difflcult matter to ii;o- A port this conjecture by pfaufible reafcnmg X 3 and 3 io MEDICAL SKETCHES. and illuflration ; but it is of little import- ance in itfelf, and of perfect indifference to me, whether it be believed or not. Whatever may be the general or parti- cular caufes of fevers, none of them adt with fuch certainty at all times, as that fever muji follow, as often as the human conftitution is expofed to their influence. For although experience proves, that fevers of an inflammatory nature prevail in cold weather, and thofe of a remitting kind after heat and moifture; yet experience affords many exceptions to this general courfe, and fometimes affords examples of the reverfe. We alfo fee people fcized with fevers at feafons when no epidemic reigns, and when they have not been expofed to any of the caufes which are confidered as the fources of that diftemper. 9 MEDICAL SKETCHES. 311 And we fee others preferve perfect health during the progrefs of the fevereft epide- mics, and notwithftanding their being by neceflity or imprudence much expofed to the infection. For befides. all the remote caufes of fever, there muft alfo be a particular difpofition in the conftitution of the individual, to favour the adlion of the morbific caufe, and render him fufceptible of the difeafe, without which, however much he may be expofed to the other remote caufes, he will not, at that particular time, be feized with it. Perfons of a fanguine habit are certainly more fubjedt to inflammatory complaints than thofe who are lefs plethoric ; as the more delicate and weakly are found to be more liable to the nervous fever, than the ftrong and robuft. Other ftrongly marked peculiarities of conftitution may predifpofe to particular difeafes; but that important power in the conftitution, by which it is X 4 enabled 312 MEDICAL SKETCHES, enabled to reject fever at one time, and of which it feems deprived at another, has never been explained. Yet many chimerical fyflems intended to afcertain this, and demonftrate the im- mediate caufes of all fevers and all their dif- ferences, have been received as fatisfa&ory in different ages, being introduced by the influence of fome great name, and agree- able to the prevailing philofophy of the times. The different temperaments of the human body have been divided into the various claffes of hot and cold, moifl: and dry; and from the proportions in which thofe were mingled, the caufes and nature of fevers were deduced. At one period imagination fo entirely got the better of judgment, that the cure of particular organs was expected from cer- tain fubftances, for no other reafon than a refemblance MEDICAL SKETCHES. 313 refemblance between that fubflance and the organ difeafed. Thus euphrafia was recommended for complaints of . the eyes, pulmonaria for thofe of the lungs, lemons for thofe of the heart, afarum and fatyrion on account of other chimerical refetn- blances. At another period all the phenomena of fevers were explained by the predominancy of acid, or of alkali, in the conftitution ; and at a different period nitre and fal ammoniac having been obferved to refrigerate water, a fuppofed preponderency of one or both of thefe was thought a fufhcient explanation of the cold fits of fevers. If the fymptoms were very turbulent and ungovernable, their impetuofity was thought to be clearly accounted for by the deflagration faid to refult from the combination of fulphureous and nitrous particles in the human body. — ■ And when any conftituent part of the blood or juices was fuppofed to prevail in undue proportion, or any particular morbid hu~ I mour 3H MEDICAL SKETCHES. mour fuppofed to exift, thofe enthufiafts feem to have been perfuaded it was in their power to precipitate, diftil, or fublimate them in the human body as they could any fubftance in a pot, an alembic, or a tire of arundels. The chymical were followed by the me- chanical phyfiologifts, who law wedges and darts in the animal fluids, with which they exceedingly annoyed all their antagonifts, and finally drove their predeceflors almoft entirely from the fchools of medicine. Many ingenious and learned men adopted the idea, that the operations of the animal ceconomy are to be accounted for on me- chanical principles, and the caufes of dif- eafes and operation of medicines, are to be explained by the laws of hydroftatics. There muft however be unfurmountable difficulty in applying the laws which govern paffive matter to living animals j and the axioms I MEDICAL SKETCHES. 3 X 5 4x10ms which are juft when applied to in- flexible pipes, will be found erroneous, and to lead into falfe calculations, when applied to thofe which are elaftic, and changing their capacity every inftant. An obftacle of fomething of the fame nature prevents our forming conclufions that can be relied upon, concerning the ef- fect of feptic and antifeptic medicines on the living body, from the effeCt they are found to have on dead animal fubftances. The experience of ages has proved, that the great and ultimate object of the art of medicine ,- — the power of caring difeafes , is more effectually attained by diligently ob- ferving the courfe and fymptoms of dis- tempers, and the effeCts of the means ufed for their relief, than by the moft plaufible reafonings on their fuppofed nature and caufes. Yet the latter has proved more at- tractive to many ingenious men of the pro- feflion, and, for a reafon Sufficiently obvious. in 3 i6 medical sketches. in a particular manner to fuch as are em- ployed in lecturing to ftudents. No fyftem was ever received with more nniverfal approbation than that of Boer- haave. The acknowledged learning, in- genuity, and integrity of that illuftrious profeiTor, aided the plaufibility of his theory in producing conviction. The leading maxims of this fyftem is, that all local in- flammation depends on obftru&ions ab errore loci , as he terms it ; that is, when globules of blood get by miftake, as it were, into veffels whofe diameters are too fmall to permit them to pafs. That inflammatory fevers are owing to a vifcidity or lentor prevailing in the mafs of blood and ftagnating in the capillary veffels. When this is attended with a particular acrimony in the juices, whether received before the fever, or formed by the fever it- felf, the difeafe he then fuppofes to be of the putrid clafs. Such MEDICAL SKETCHES. 3*7 Such is the foundation of the do&rine taught for many years by Boerhaave at Leyden, in his time the molt celebrated fchool of medicine in the world ; and by the means of this he endeavours to explain all the phenomena of fevers, and to account for the various terminations of inflammation in refolution, fuppuration, gangrene, or fchirrus. His audience heard him with implicit be- lief, and fpread his dodtrine with all the zeal of convi&ion over Europe. The ideas of Boerhaave acquired ad- ditional force and celebrity from the valuable commentaries and illuftrations of one of his difciples, the Baron Van Swieten, a man diftinguilhed by his learning and talents, and placed at the head of medicine in Ger- many, by the well-diredted favour of the late Emprefs. So that no theoretical fyftem of medicine was ever introduced more advantageoufly. was- 3x8 MEDICAL SKETCHES. was fupported with greater abilities, or pro- mifed to be more permanent. Of late, however, it has been ftrenu- oufly attacked, lofes ground daily on the continent of Europe, and in this ifland leems to be almoft, if not entirely over- turned. But from whatever caufe it pro- ceeds, there indifputably does exift, during the cold fit of a fever, a ftoppage of the blood and fluids in the minute arteries and excretory veflels of the body, as appears from the palenefs of the fkin and lips, dry- nefs of the fkin and mouth, and the drying up even of iflues and ulcers. Thofe there- fore who rejedt Boerhaave’s explanation by a fuppofed vifcidity or thickening of the fluids, were obliged to account for all thofe fymptoms otherwife. They accordingly afiert, that the fault does not lie in the cir- culating fluids, but in the extreme veflels, which we are told are fuddenly feized with fuch a conftridtion as refufes all paflage to the MEDICAL SKETCHES. 3x9 the blood as effectually as if it were con- verted into glue. They infift farther, that if this vilcidity were to be admitted, it mull be fuppofed to take place gradually , and of courfe would require confiderable time to be produced, and would indicate its progrefs by fome un- eafy feeling or complaint ; but the cold fit of fevers often attacks at once without any previous complaint, unlefs it is a fenfe of weaknefs a ihort time before. In their opinion, therefore, a fpafmodic conftriCtion of the extreme veffels accounts for all the phenomena of the cold fit much more naturally, and is analogous to the effeCt of certain fudden affections of the mind, as furprize and fear, which inftantly produce the fame phenomena. Befides, the lentor fuppofed, if it really took place in a liquor whofe free circulation is effential to life, would never fail to prove mortal ; but as people daily recover from inflammatory 320 MEDICAL SKETCHES. inflammatory difeafes, this circumftance alone is a proof that no imiverfal lentor does take place in fuch difeafes. It is farther alleged, not only that there is no pofitive evidence of vifcidity, but that there is reafon to believe that even at the beginning, as well as during the progrefs of inflammatory fevers, the blood is lefs vifcid than in perfect health ; for it is natural to think that a thin liquor, other circumftances being equal, will coagulate more flowly than a thick ; and as it is found, in fadt, that the blood of people labouring under inflammatory diforders is longer in coagu- lating when drawn out of the body, than that of people in perfect health, tbofe who combat the notion of lentor prefume from thence that the blood of the former is the thin- ner of the two ; and add, that the gluey buff- coloured pellicle which forms itfelf on tire furface of inflamed blood, and wa§ confidered as an irrefragable proof of the morbid MEDICAL SKETCHES, 321 morbid vifcidity in queftion, is no proof at all, this pellicle being nothing elfe but the natural coagulable lymph of the blood left at the furface and forfaken by the red particles, which the flow coagulation of inflamed blood permits to fall to the bottom. With regard to the theory of local in- flammation ab err ore loci , or blood globules getting into veflels which from the narrow- nefs of their diameters and conical form they cannot pafs, and which, it is faid, the fucceeding fluid muft propel with increa£ ing force, and produce the following fymptoms ; J welling and rednefs , by the accumulation of blood in the minute veflels ; pain, by the diftention of thofe veflels ; heat , by the agitation and rubbing of the glo- bules; and throbbing , by the beating of the obftrudted artery ; or in one word, produce inflammation . All 322 MEDICAL SKETCHES. All this is without ceremony or circum- locution now denied ; and it is farther afferted, that when examined by a m'cro- fcope, the blood is feen to pafs through the arteries of an inflamed part with as much eafe and more rapidity than through thofe of a part not inflamed ; and whether the part be inflamed or not, that when a red globule enters a veflel too fmall for its tranf- miflion, it is forced back by the contra&ion of the veflel ; for the force of the heart in thofe minute and diftant arteries is fpent, and has no effedt, and the globule thus t thrufl: back enters fome larger anaftamofing branch without occaficning any obftrudtion or ftagnation. * • The many fenfible refledlions and prac- tical obfervations made by Boerhaave, and the judicious commentator on his works, will continue a permanent and ufeful monument of their knowledge and induftry, although the whole fabric of their theory, fo MEDICAL SKETCHES* 323 fo long confidered as folid and fubftantial, fhould vanifh like the bafelefs fabric of a vifon. We need be the lefs affonifhed at finding the theory of Boerhaave in danger of being overfet, when we confider that one of the moft important and comprehenfive opinions of all medical antiquity, which originally came from Hippocrates himfelf, and like a folid body falling from a vaft height, feemed to acquire additional force as it defcended through admiring ages, is now openly im- pugned, and its truth difputed. The opi- nion in queftion is, that a fever is nothing elfe but an effort of Nature to expel fome noxious matter from the conftitution ; but before it can perform this, it is neceffary very often that this noxious matter fliould undergo codlion. Coblioti , in medical lan- guage, is a term ufed to fignify the procefs ..by which Nature attempts to operate fuch an alteration in this noxious matter as de- Y 2 prives 324 MEDICAL SKETCHES. prives it of its pernicious qualities, or renders it capable of being expelled through fome of the emundories of the body. The noxious matter however is fuppofed to be averfe to this codion, and ftruggles againft it with more or lefs fuccefs, according to the virulency of the matter and the powers of the conftitution. In this ftruggle between the noxious matter and the conftitution the fever confifts. When Nature is ftrong enough to perform perfect codion and expulfion, health is immediately reftored ; when Nature is quite unequal to the talk, the patient dies ; when fhe per- forms it imperfedly, there is an abatement of the difeafe ; but a new effort muft be made after a fhort paufe, and this is called relapfmg into the fever. This dodrine was believed with a degree of convidion that in general is only com- pelled by mathematical demonftration, or given to the evidence of the fenfes ; and phyficians were accuftomed to fpeak with i . as MEDICAL SKETCHES. 325 as much certainty of the co